User Guide — Ambulance Billing

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If your practice manages ambulance billing, you can use the Ambulance Billing feature to track billing for ambulance services.

 

If your practice manages ambulance billing, you can use the Ambulance Billing feature to track billing for ambulance services.

 

 

 

With the Ambulance Billing feature enabled and configured, athenaOne:

  1. Automatically completes the ambulance point-to-point modifier — On transportation claims, you add a modifier to describe at what type of location the service started and ended. For example, if a trip started at a physician's office and ended at a hospital, you append the modifier PH to all the charges for that trip.
  2. Automatically sets a contracted service location to service location mileage on claim creation — If you create a claim with the starting location, ending location, and insurance package associated with a service location mapping, the mileage associated with that mapping is added to the claim.
  3. Automatically scrubs the claim — If you drop a claim with a starting location, ending location, and insurance package associated with a service location mapping, then a rule scrubs the claim to hold for a staff member to correct the mileage or override the claim rule.

Two admin pages are associated with the Ambulance Billing feature: the Service Locations page and the Service Location Mappings page. These pages are used to record information about ambulance billing companies.

 

On the Service Locations page, you can:

  • Add facility locations with which ambulance companies frequently interact.
  • Associate the facilities with a case policy (where applicable).
  • Add places of service.
  • Add an ambulance-specific modifier code.

If the ambulance companies have case policies where transportation between two service locations is always billed at a specific mileage, you can store that information on the Service Location Mappings page.

 

Locations are part of an ambulance claim and are also captured in the Service Type Add-on for ambulance billing. You must use the Service Locations page to manage and edit the locations serviced.

 

 

 

  1. Display the Service Locations page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Ambulance Billing, click Service Locations.
  2. Click Add new.
    Additional fields appear.
  3. Provider group — Select a provider group from the menu. (This field appears only if your practice uses provider groups.)
  4. Name — Enter a name for the service location.
  5. Address — Enter the street address of the service location.
  6. Address (cont.) — Enter any additional address information (apartment number, suite number, etc.).
  7. ZIP Code — Enter the ZIP code of the service location or click Lookup to display the USPS ZIP code lookup tool in a new window.
  8. City — Enter the city of the service location.
  9. State — Select the state of the service location.
  10. Phone number — Enter the phone number of the service location.
  11. Place of service type — Select the type of service that the location provides (for example, hospital, school, or nursing facility).
  12. Ambulance service claim modifier — Select the modifier that best describes the service location.
  13. Contract package — Click Choose package.
    The Insurance Lookup page appears in a new window.
  14. Policy Type — Select Standard Insurance or Case Policy.
  15. If you selected Standard Insurance in the Policy Type field, enter some or all of the following information.
    1. Insurance company name — Enter the name of the insurance company (this field is required).
    2. Insurance Address — Enter the address, if you have it (you can enter a partial address).
    3. Product Type — Select the insurance product type from the menu (for example, PPO, HMO, POS, or Medicare Supplement).
    4. Insurance Type — Select the insurance type from the menu (for example, Commercial or Medicare Replacement).
  16. If you selected Case Policy in the Policy Type field, enter some or all of the following information.
    1. Insurance company name — Enter the name of the insurance company (this field is required).
    2. Insurance Address — Enter the address, if you have it (you can enter a partial address).
    3. Case Policy Type — Select the case policy type from the menu (for example, Contracts, Legal, Auto Insurance, or Worker's Comp).
  17. Click the Lookup button.
    The search results appear.
  18. Click Select next to the package.
  19. Click Save or Save and Add Another.

 

 

To filter the list of service locations, enter information in one or more of the search fields.

  1. Display the Service Locations page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Ambulance Billing, click Service Locations.
  2. Provider group — Select a provider group from the menu. (This field appears only if your practice uses provider groups.)
  3. Name — Enter a service location name to filter the results by name. The athenaOne search logic produces results where your entry matches any part of the name field.
  4. Address — Enter a service location address to filter the results by address.
  5. City — Enter the city of a service location to filter the results by city.
  6. State — Enter the state of a service location to filter the results by state.
  7. ZIP Code — Enter the ZIP code of a service location to filter the results by ZIP code.
  8. Contract package — Click Choose package.
    The Insurance Lookup page appears in a new window.
    1. Policy Type — Select Standard Insurance or Case Policy.
    2. Insurance company name — Enter the name of the insurance company (this field is required).
    3. Enter other search criteria (Insurance Address, Insurance Type, Case Policy Type) and then click Lookup.
      A list of matching policies appears.
    4. Click Select next to the package that you want to filter the list by.
  9. Click Filter.
    The search results appear in the service location table. To return to the full table view, click Reset.

 

  1. Display the Service Location Mappings page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Ambulance Billing, click Service Location Mappings.
  2. Pickup — Enter any part of the location where the ambulance picks up to filter the results by the pickup location. The athenaOne search logic produces results where your entry matches any part of the location record (i.e., portions of the name, address, or ZIP code).
    This field displays matching locations entered on the Service Locations page. Select the pickup location.
  3. Destination — Enter any part of the location where the ambulance delivers to filter the results by destination location. The athenaOne search logic produces results where your entry matches any part of the location record (i.e., portions of the name, address, or ZIP code).
    This field displays matching locations entered on the Service Locations page. Select the destination.
  4. Contract policy — Click choose a package and select the insurance case policy in the pop-up window to filter the results by contract policy.
  5. Click Filter.
    The search results appear in the service location table. To return to the full table view, click Reset.

 

  1. Display the Claim Edit page: In the text box at the top right of your screen, enter the claim number, select Claim ID from the menu, and then click the search icon. The Find tool looks for an exact claim ID match. (Searching for claims requires claim billing user permissions.)
  2. Scroll down to the Service Type Add-on section and note the two location columns for Pickup and Destination. An interface typically populates most of the fields under the Pickup and Destination labels.

Pickup

  1. Custom Address — Enter the new address to update the pickup location, or select Service Location to select a predefined location configured on the Service Locations page.
  2. Name — Enter any part of the location name to display a list of matching locations. When you select the location, the full address and location type is populated in the STAO for this claim.

Destination

  1. Custom Address — Enter the new address to update the destination location, or select Service Location to select a predefined location configured on the Service Locations page.
  2. Click Save.

 

 

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