Revenue-Guard Services
Revenue Guard provides EMS consulting services as well as medical billing and collection solutions to the ambulance services industry. We offer a full spectrum of services including pre-hospital information management, revenue cycle management, accounts receivable management and EMS business management services. We also provide ongoing support and financial performance analysis to hospitals, EMS management teams and facility chief financial officers. Additionally, Revenue Guard services help to minimize audit liability.
Revenue-Cycle Management
Revenue-Guard supplies ambulance providers with the technology and consulting services needed to cover the full spectrum of their revenue cycle needs. Revenue-Guard assists with everything from the pre-bill function to pre-hospital information management to aggressively addressing complicated claim denials. Revenue-Guard also supports EMS directors and hospital financial administrators in all industry clinical, administrative and operational matters with the focus on operational cost controls, compliance and revenue maximization.
Medicare Compliance Training
Revenue Guard provides Medicare compliance training to all clients’ administrative and field personnel. This includes medical necessity, documentation, HIPAA, ABN (Advanced Beneficiary Notification) requirements and OIG (Office of Inspector General) compliance.
EMS Management Services
Revenue Guard also provides EMS management and consulting services to our clients. Services provided include System Status Management and Field Demand Analysis. Additionally, the company provides assistance in the areas of forecasting and labor resources, budgeting, increasing marketplace penetration, OIG compliance, electronic PCR management and revenue maximization.
Review of Revenue Guard Services
Department Budgeting
Assist EMS departments with budget forecasting, with an emphasis on strict payroll and schedule controls.
Labor Resources
Identify and search for high quality EMS field staff to maintain department stability.
EMS Department Performance Statistics
Supply EMS directors and financial administrators with a detailed snapshot of statistics that focus on compliance, cost controls, claims submission, and revenue maximization.
Marketplace Penetration
Evaluate and identify our clients’ position and impact in their geographic catchment area.
Managed Care Marketplace Evaluation
Analyze and assist clients with pricing benchmarks based on costs, market rates, and contract terms.
RAC Audit Liabilities
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During the RAC demonstration period, recoupments fall into the following three (3) main categories:
- 50% of claims are denied due to improper coding
- 33% of claims are denied for failure to meet medical necessity, or because procedures (a) were performed in the wrong setting, (b) lacked administrative criteria, or (c) the hospital failed to provide proper documentation of the medical reasoning.
- 10% of denied claims were the result of hospitals not responding within the required 45-day period with the appropriate documentation.
- Provider coding – Starts with a strong comprehensive field date capture system that is focused on strict Medicare guidelines.
- Past Claims – Identify potentially vulnerable areas by reviewing past claim submissions as well as reviewing medical necessity compliance during the pre-bill and data input process.
- Revenue Guard supplies continuous on-site Medicare manual, Medical necessity, HIPAA, and advanced beneficiary notification ABN to 9-1-1 field EMT and paramedic staff.