The Shocking Cost of Air Ambulance Services
Background
ClaimDOC’s comprehensive line-by-line auditing of claims uncovers errors that basic claim repricing and auto-adjudication does not catch, leading to greater savings for health plans and its plan members. Our audit team analyzes all types of healthcare claims for a variety of potential concerns including excessive usual and customary charges, duplication of claims, correct coding edits, unbundling of services and many others. Our claims review is not intended to impact care decisions or medical practice.
In this Claims Audit Spotlight, we focus on air ambulance services and their related charges which in most instances are considered “shocking.”
Air ambulance is also known as medical air transport – any form of aircraft equipped with supplies, equipment, and qualified medical professionals that will provide mobile care during transport. Air ambulances are used to transport patients in critical situations from the scene of an injury or accident to hospitals or between hospitals to obtain certain services, or other situations. Coverage and benefits of air transport may be included in health insurance or travel insurance.
News headlines frequently report on high air ambulance service charges. These articles find ambulance companies are balance billing patients for air ambulance transport and present patients with surprise bills.
According to Air Ambulance NPRM – Fact Sheet, September 10, 2021, “Air ambulance services frequently result in surprise medical bills due to individuals’ inability to select an in-network provider when faced with an urgent medical situation. A 2019 study by the Government Accountability Office (GAO) found that 69 percent of air ambulance transports of privately insured patients were out-of-network in 2017 and that for privately insured patients, the median price charged by providers of air ambulance services was $36,400 for helicopter transport and $40,600 for a fixed-wing transport in 2017.”
Billing Ambulance Services
The reporting and billing of ambulance services on insurance claims requires specific details such as, the point of pickup zip code, dates of service, HCPCS code(s) for the type of air service (fixed wing or rotary wing), origin and destination modifiers, number of loaded miles, medical diagnosis(es)/condition(s) codes, and other information.
Supplies, drugs, and ancillary services (wait time, extra attendant, oxygen) are part and partial to the air ambulance transport.
Air Ambulance Claims and Case Scenarios
1.) A 45-year-old male patient experiencing chest pain was transported by air ambulance between hospitals in Ohio for emergency surgery due to acute aortic dissection found on CT scan.
The CMS-1500 claim form/electronic equivalent was reported/ billed as follows:
HCPCS code A0431 HH – (one (1) unit) and associated charge of $27,300.
HCPCS code A0436 HH – 107 units and associated charge of $25,278.75.
Total Billed Charge: $52,578.75
ClaimDOC pricing of $7,965.39 was based on the 2022 Medicare air ambulance base rate for HCPCS code/level of service, applicable adjustment factor(s), and mileage rate with markup.
Plan Savings: $44,613.36
Percentage of Savings: 85%
2.) A 56-year-old female patient experiencing a brain bleed was transported by air ambulance to a hospital in Indiana for emergency surgery.
The CMS-1500 claim form/electronic equivalent was reported/ billed as follows:
HCPCS code A0431 QN – (one (1) unit) and associated charge of $33,660.85.
HCPCS code A0436 QN – 72 units and associated charge of $28,671.50.
Total Billed Charge: $62,332.35
ClaimDOC pricing $10,253.91 based on 2022 Medicare ambulance base rate for HCPCS code/level of service, applicable adjustment factor(s), and mileage rate with markup.
Plan Savings: $52,078.44
Percentage of Savings: 84%
The Takeaway
Concerns of egregious charges were observed on the above two air ambulance health insurance claims. While air ambulances may freely charge their elected and associated fees for services provided, egregious fees and billing errors can complicate matters for members. These fees can impact the collection of patient balances, build a reputation of facilities charging high fees, and burden patients who do not have insurance.
While coding, billing and the reporting of healthcare services is a complicated process, simple billing errors include the submission of:
- Incorrect patient information
- Incorrect provider information
- Incorrect insurance information
- Incorrect CPT/HCPCS codes
- Incorrect modifiers
- Incorrect diagnosis(es) codes
- Incorrect quantity units
- Mismatched medical codes
- Duplicate billing
- Unbundling of services
- Erroneous charge(s) and
- Others
Whenever an individual receives a bill and the cost for care seems inappropriate/questionable, an inquiry to the provider and/or health plan should be made to obtain an explanation of the service(s) and corresponding charges.
Our goal at ClaimDOC is to use benchmark charges and costs nationally to negotiate fair and ethical payments. Employers turn to us to establish fair reimbursement rates for their plans allowing them to save money and provide richer benefits to their employees. A win-win for everyone.