If payment is denied everyone who provides that service needs to know why , not just the billing manager. Deterrence begins with identification of a problem. Most staff, including managers, do not know how the facility is reimbursed for services that they provide, or know the criteria for that reimbursement. For example, a family wants the patient, at discharge, to go to the daughter s home 50 miles away. The ambulance is ordered by the physician at the family s request.
Staff is unaware that the destination is out of the allowable mileage range.
These and many other nuances create nightmares for the billing department. Meanwhile, unit staff have no idea that all their effort resulted in no reimbursement for the facility. Under generally accepted principles of agency, the actions or omissions of an agent or employee are linked to the corporate entity. Given the application of the law, it is easy to see how the government can arrive at multimillion dollar settlements. The civil laws that were broken, might give way to a more devastating criminal component if the government chooses to prosecute intentional false claims or statements made to Medicare, Medicaid or other state health agencies.