Billers and Clinicians, an Unlikely Friendship: Supporting Sustainability in a Not-For-Profit Setting

Information deserves authority. Ironically, sometimes the subject-matter experts in a particular field lack crucial information to drive their outputs. Clinical crews involved in air medical transport undoubtedly deliver the best possible care and treatment to their patients, but they don’t always generate the best documentation to memorialize their efforts. Non-operational staff in the medical transport industry have a lot to offer when it comes to the production of accurate and detailed patient care records—especially if they work in the billing department! However, such staff are rarely consulted when clinical leaders initiate improvement projects.
This presentation will describe how the Clinical Department and the Billing Department at Life Flight Network worked closely with the Quality Management Department to identify an issue, gather historical data, eliminate gaps in documentation from patient care records, and ultimately reduce the numbers of write-offs, downcodes, and outright denials from insurers.
The opportunity to collaborate on this Action Plan coincided with changes in healthcare legislation, namely the No Suprises Act. While patients and their families get a certain level of protection from the NSA, it is incumbent upon the air medical transport industry to also do everything possible to make excellent healthcare available and sustainable for everyone. It turns out that the IDR (Independent Dispute Resolution) process often contributes not only to confusing and drawn-out verdicts, but it also often results in reduced reimbursements for healthcare providers. However, accurate and detailed clinical documentation can help avoid the IDR process altogether, thereby ensuring sustainable operations for providers and minimizing the potential impact to patients from the psychological and emotional consequences of overwhelming medical bills--not to mention reluctance to engage in healthcare services in the future due to negative experiences with the billing process.

Learning Objectives:

• Upon completion, participants will be able to describe strategies, including implementation of an Action Plan, in order to increase the quality and accuracy of clinical documentation
• Upon completion, participants will be able to identify at least three areas for improvement in clinical documentation that could be leading to unnecessary denials from insurers
• Upon completion, participants will be able to summarize the NSA and IDR process, as well as articulate their effects on the medical transport industry