Mohawk EMS Case Study

Mohawk EMS Case Study

The Challenge

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Reduce the number of screens, websites and systems searched by billers to find information and populate a claim

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Eliminate lag days waiting for verification, deductible screening and insurance discovery

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Find more insurance coverage to reduce eligibility-related rejections, convert self-pay accounts and collect revenue from the right source

The Solution

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Integrate Payor Logic insurance verification and discovery into front-end workflow for real-time searches versus batch processing

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Use Payor Logic demographic verifier to validate patient data and fill in the blanks for emergency transports

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Reduce the number of patient statements by finding and billing insurance coverage first

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Improvement in staff efficiency for insurance verification

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Less time needed per case to screen for Medicare deductibles

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Elimination of wait times to discover billable insurance for self-pay patients

Mohawk Ambulance Service

Real-time insurance discovery and verification services eliminate lags, expedite claims and achieve 30 percent greater staff efficiency for EMS provider

Founded in 1964, now nationally recognized, Mohawk Ambulance Service is the largest privately owned ambulance service in upstate New York.

The EMS provider services six emergency centers, makes 56,000 trips annually and employs a team of more than 250 staff members. Mohawk’s mission is to uphold the highest standard of EMS services with consistent devotion to delivering superior emergency medical care. Wendy Becofsky, business office manager and her management team commits the same level of service excellence to the organization’s revenue cycle.

Becofsky’s team maintains a vigilant watch over the verification, billing and collection functions at Mohawk. Working together with local hospitals and nursing homes, they have fine-tuned many standard processes—checks and balances to verify coverage, screen deductibles and reduce eligibility-related rejections before claims are submitted to a payer. The verification team also performs insurance discovery for patients without insurance.

Eighty percent of our trips are for emergency transports—where patients are unknown, in critical condition or have no identifying information. Finding fast, efficient ways to verify demographics and discover insurance coverage is imperative.

Wendy Becofsky

Business Office Manager

Real-Time Insurance Discovery Eliminates Batches

To achieve her efficiency goals, Becofsky turned to long-time technology and service partner Payor LogicTM to innovate Mohawk’s insurance discovery process for patients with no known coverage.

Mohawk’s original process 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. With efficiency in mind, Payor Logic recommended a new workflow and technological capability.

Payor Logic provided an interface for Mohawk billers to access their payor search options. Now the insurance verification team at Mohawk has immediate access to Payor 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 dramatically reduce the number of patient statements they send.

Becofsky has been with Mohawk for more than 20 years and describes Payor Logic’s new real-time insurance discovery option as “amazing.”

The efficiency our verification team is able to achieve is amazing. This is a huge feature that we were only able to acquire through the Payor Logic partnership.

Automated Verification and Discovery Capabilities Increase Staff Efficiency

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.

“We’ve always done up-front verification, but now our processes are more efficient, more immediate and more effective,” concludes Becofsky.

Common Self-Pay Scenario for EMS Providers

Ambulance providers are often called upon to trans- port patients experiencing chest pain, but with no information available. Billing the patient directly instead of submitting a Medicare claim leads to a lengthy payment delay—30 to 90 days or more. If correct demographics and insurance coverage can be identified up front through better automation, the EMS staff can easily identify Medicare and submit the claim—and expect to receive payment within 14 days.

About Payor Logic

As a pioneering innovator in accounts receivable solutions and insurance discovery technologies, Payor Logic enables healthcare organizations – from health systems, to EMS providers and billing companies – to ensure cleaner patient data, faster reimbursement and simpler self-pay management.

To learn more, visit www.payorlogic.com, or call us at: 888.990.6624.