Fourth Quarter of 2009

In this section:

• Accepting Assignment / Being a Participating Provider
• The Difference Between Code Questionnaire and Call Questionnaire items

Accepting Assignment / Being a Participating Provider by Kathy Ransom

“Accepting Assignment” (also referred to as being a “Participating Provider”) means that the ambulance service receives a direct payment from the insurance company for an approved amount; the ambulance service then adjustments the balance and only charges the patient for the co-pay amount or the deductible charges determined by the insurance plan.

Medicare and Medicaid both require ambulance companies to accept their payment as payment-in-full according to the set fee schedules. Commercial insurance companies can also set up an agreement with the ambulance companies to agree to their payment as payment-in-full.

If you choose to be a Non-Participating Provider or not Accept Assignment, then payment will be sent to the patient and rather then directly to the ambulance company, which could include additional challenges such as trying to collect directly from the patient, especially in these economic times. Non-Participating Providers will still need to send the claim to the insurance company and then also bill the patient.

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Do You Know the Difference Between "Code Questionnaire" and "Call Questionnaire" items? by Christine McConnell

Call Questionnaire items are questionnaire items that are specific about the call. For example – “Transported To/For” - this is a question regarding the call itself. To turn on this specific questionnaire item:

• go to “Utilities/Call Data Setup”
• click on the search button
• select the call type you are using
• click on the Questionnaire tab
• “Questionnaire Type” should be the default of “Call Questionnaire Tab”
• click on the “Question” drop-down box
• find the question you need and high-light it and then click “Accept”
• make sure to save your changes to the call type

Code Questionnaire items are items for a specific code file. For example - on the Payor code file, questionnaire item of “CMS box 24J Provider ID.” The majority of the time these would be either insurance specific answers or state specific answers for that type of code file. To turn on a code file questionnaire item:

• go to “Utilities/Code Setup”
• in the “Code” drop-down box, select the code file you are working with (in this case we would select “Payor Codes”)
• then from the “Question” drop-down box, find the question you need, high-light it and then click “Accept”
• click “OK”