Office and Operations— A Partnership

Who’s Driving the Bus?
Why do we have so many “slang” terms for the ambulance vehicle in EMS? Where did they all come from?

I’m just as guilty as anyone for referring to an ambulance as a truck, unit, squad, rig, and my all-time favorite, “bus!” Using one of these terms, I pose a question for you:

Who’s driving the bus in your organization?

Is your office overpowering operations or is the operations side running rough-shod over the office?

Cooperation and Balance
Every good EMS organization must find a way to develop cooperation and balance on all sides. Our EMS departments must function as a partnership, where street crew staff members and front-office personnel work in concert and not in conflict.

As a billing outsourcing partner to many EMS organizations all across the United States, we see organizations that have this partnership down to a science. Those organizations, not coincidentally, are usually the most successful ones.

Unfortunately, we also see many organizations where one side dictates what the other side does in practice. Conversely, those are usually the departments that face the most obstacles.

Mutual Respect and Understanding
In order to function optimally, the street staff and the office staff must develop a mutual respect and understanding of each other’s function. At no time should one side of the equation stomp on the other side.

Many times, both sides have good intentions, but the end result can be disastrous to day-to-day operations.

For example, we have seen organizations where the office staff completely dictates field operations and decisions. 

Just last week, we were told of a billing company representative that visited a neighboring service to one of our clients and conducted a “class” for the street staff. This biller passed out information and instructed the attendees on “exactly how to write” trip sheets so certain scenarios would get paid, with no apparent consideration to whether those patients truly needed an ambulance or not.

Say what?
One of the staff members from that company where the “class” was conducted, then pulled a shift with our client’s service and proceeded to inquire of the manager; “Why doesn’t your billing company come tell us what to write in our PCRs?”

Fortunately, our client’s manager understands that all Patient Care Reports should be written as a factual representation of the treatment and transport scenario and certainly not written so the trip will “get paid” by whatever insurance. Our client’s manager proceeded to educate that staff member that it is not acceptable for his organization to dictate what a provider should write in his/her PCR just to “get paid.”

For the record, Enhanced does provide documentation training, but it’s a true class of instruction on how to independently record in writing the events of the scenario and NOT a coaching session on how to write a chart to get paid regardless of the events of the day.

Another example are those departments we have heard of that dictate to their street staff, “Never document that a patient walked to the litter, because the claim may not get paid.” Or, “Always do an ALS intervention, whether or not the patient needs it, so we can make more money.”

There’s just no place in today’s EMS for those kinds of directives. The office is just dictating too much to the street side of the operation.

The Other Side of the Coin
Unfortunately, it’s not always the office that lords over the street. Too often, providers encroach on the office.

This is the other side of the coin, so to speak.

We can’t tell you how many Patient Care Reports we read that lack very important details. We visit EMS organizations all the time that have the best equipment, extremely capable providers and SOPs that will fill a library.

Then we read PCRs from providers in that same organization that miss the mark in describing the basics of the call. When we read the documentation written in the PCR, we often find that the excellence we see in every other part of the organization is lacking in adequately defining the scenario by painting a picture in words, which is essential in today’s EMS environment for compliance, billing, legal protection, etc.

So the front office and the billing staff continually return PCRs to providers for review and reflection as they fail to pass QA/QI reviews and basic compliance checks. The provider community then proceeds to throw a collective tantrum because “Who are they to dare question the greatest trip sheet ever written?” You know, MY trip sheet…that Pulitzer Prize winning doctoral thesis dissertation that I took ten minutes to write.

Then there are the Operations people that dictate what the office staff does, or at least they try. You know, the manager that demands non-emergency claims be billed for patients whose conditions do not meet the medical necessity guidelines by giving  the billing office all kind of heat over claims that should never be billed.

Most office staff, especially billing office staff, follow the trends in the industry.  We all read account after account of ambulance owners, administrators, operations supervisors and billing staff members who are indicted with fraud and abuse allegations and many times are convicted because they pushed the envelope on the rules too hard. Is the money derived from one claim actually worth billing if, in the end, the money’s going to be paid back, most likely with interest and that same administrator winds up convicted of a crime? No way!

If that’s you (and we sincerely hope that it’s not), you are doing yourself, your department and your colleagues a tremendous disservice. Plus, you are eroding any confidence that the public has in our EMS system, when confidence is so crucial to our mission.

Cut your front office some slack, especially the billers. Cut your billing company some slack. While it’s our job as billers to collect every dime we can, it’s also our job to keep our organizations  squeaky clean and between the lines when it comes to compliance. Step back and think about what you’re asking your office to ,and how hard you will push until something bad happens and your organization, and possibly your career, is ruined forever.

An Aversion to “Head Butting”
But because we haven’t found a way to work together within many of our organizations, we accept mediocrity in the name of not wanting to “butt heads.”

Operations concedes and buckles under to the office. Office staff back away from demanding excellence coming from the street because it’s too difficult to communicate.

Why can’t we all get together and discuss why certain things have to be approached in certain ways? It’s called COOPERATION!

Neither side, office nor operations, should ever accept that one overrides the other, especially in today’s challenging world where compliance audits are becoming more the norm than the exception. Where reimbursement dollars are failing to keep pace with spiraling costs and where working smarter rather than harder is what it will take to keep the trucks on the street.

We must all find a way to work together. Each side compliments the other. Handled effectively with mutual respect and cooperation, both sides will win, as you’ll find it takes minimal effort to accomplish the major goals that both sides work to achieve.

Here are a few of our suggestions…

Office staff should meet with operations staff on a regular basis. Where there is dialogue there is understanding, in most cases.

Both sides should spend some time in the other side’s wheelhouse. If you’re office functions are in-house, try job swapping as a means of promoting understanding. Office staff can ride the ambulance periodically to understand how difficult it is to obtain a patient signature from a drunk at 3 a.m. Street staff may benefit from sitting in an office chair every now and then, reading a PCR and attempting to QA/QI the trip and determine if the bill should advance to the office for billing based on rules and regulations.

If you outsource billing, ask your billing company for guidance and information to help you achieve your goals. Be sure to share changes and goals that are set by your organization with key billing company contacts. Billing contractors are often the last in the food chain to be notified by the client when something major takes place in their organization. That major change may be something that the outsourcing company needs to know and can help you enact more smoothly.

In addition, read and distribute written billing company memos (where applicable), education pieces, website posts, e-mail blasts or other information that is provided by the billing company for the benefit of your entire organization. While most billing companies spend a lot of time interacting with your office staff, it wouldn’t hurt for the street staff to get a feel for that interaction between billing company and your organization too.

If the office staff isn’t sharing the information with the staff, how can the staff comply to meet the requirement?

Finally, encourage the free-flow of ideas. Provide some means for both sides to suggest ideas anonymously, as well as on-the-record. You may be surprised at the ideas for cooperation that are percolating in the minds of your rank-and-file…now it’s time to mine those nuggets and work toward implementation.

If all members of your organization have a stake in the outcome, we think you’ll find that things go a lot smoother. Periodically explain how certain directives from the office have benefited the street side and vice-versa.

Information is the Key
Enhanced has invested a lot of time and energy into technology tools that allow for the sharing of information. We provide verbal and written support in many forms to our clients so the opportunity to tie together what happens in the billing office and on the street can be merged, especially now that we have rolled out our highly capable Enhanced PulsePoint™ and Enhanced PulsePoint™ Mobile solutions.

If you’re not an Enhanced client and you want to learn more about how our company can help you bridge the gap between your department’s Office and Operations, contact Business Development Manager, Chuck Humphrey, for more details. You can reach him via e-mail at or by calling our toll-free number (800) 369-7544, Extension 108.

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