Mohawk Ambulance Verifies Insurance Coverage at Real-Time Speeds

Name of Organization: Mohawk Ambulance Service

Industry: Healthcare

Location: Schenectady, N.Y., USA

Opportunity or Challenge Encountered

When someone is in an accident or suddenly falls ill, ambulance services are on the scene quickly to transport the injured to the nearest healthcare facility. However, running such a service is costly, and there’s little opportunity to gather insurance or payment information from a distressed patient.

“Ambulance providers are often called upon to transport patients experiencing chest pain, but with no information available,” according to a recent Mohawk Ambulance Service case study. “Billing the patient directly instead of submitting a Medicare claim leads to a lengthy payment delay—30 to 90 days or more.”

This was the challenge for Mohawk Ambulance Service, which needed to find a way to increase the speed and efficiency of acting on claims, by moving the process as close to real time as possible, as documented in the case study. If it could identify correct demographics and insurance coverage up front through better automation, the EMS staff could easily identify Medicare and submit the claim — and expect to receive payment within 14 days. The goal was to find fast, efficient ways to verify demographics and discover insurance coverage.

Mohawk Ambulance Service, the largest privately owned ambulance service in upstate New York, services six emergency centers, makes 56,000 trips annually and employs a team of more than 250 staff members. Eighty percent of the services’ trips are for emergency transports — where patients are unknown, in critical condition or have no identifying information.

Taking Advantage of Payment Opportunity in Real Time

To move the payment verification process closer to real time, the ambulance service integrated Payor Logic insurance verification and discovery process for patients with no known coverage. The solution was incorporated into its front-end workflow for real-time searches versus batch processing. The solution also includes a demographic verifier to validate patient data and fill in the blanks for emergency transports. The service also sought to reduce the number of patient statements by finding and billing insurance coverage first.

To start the process, Wendy Becofsky, business office manager, assembled a management team to find demographic and insurance information for these patients involved building a list, submitting it to Payor Logic, waiting three days for feedback, and then re-entering information into the system. The company provided an interface for Mohawk billers to access their payor search options. Now the insurance verification team at Mohawk has immediate access to online Logic’s search capabilities. No more batches, no more searching payor websites, no more waiting.

Becofsky’s team queries Payor Logic online, in real time, for each self-pay case to find updated demographic information and potential coverage. With crosswalks to patient location, customizable exclusions and dynamic Medicaid tracking, Mohawk can find more insurance coverage and reduce the number of patient statements they send.

Benefits From This Initiative

Mohawk Ambulance Service’s goal was to find fast, efficient ways to verify demographics and discover insurance coverage. Reports that as a result of real-time patient information availability, 30 observe an improvement in staff efficiency for insurance verification, while 67 percent say less time is needed per case to screen for Medicare deductibles.

The company’s new percent automated verification and discovery capabilities are helping to increase staff efficiency, according to the case study. “Because the Mohawk team now finds and verifies more insurance coverage, fewer denials or rejections based on eligibility are encountered. Billers can see insurance coverage up front versus after the fact.”

(Source: PaylorLogic)

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