Completing an ePCR - 6. Billing, Outcomes & External Reporting

Completing an ePCR - 6. Billing, Outcomes & External Reporting

Purpose Statement

The Billing, Outcomes & External Reporting section within the ePCR enables comprehensive documentation of consumable items, billing information, patient outcomes, and external report references. This functionality ensures complete incident documentation for billing compliance, quality assurance tracking, and integration with external reporting systems while supporting revenue cycle management and patient care follow-up requirements.


Background Information

This section represents the final documentation phase of patient care records, capturing critical information that extends beyond immediate patient care to include financial, outcome, and administrative data. The comprehensive nature of this section supports multiple operational needs including CMS billing compliance, quality improvement initiatives, patient outcome tracking, and integration with external healthcare systems. Proper completion ensures accurate reimbursement, supports performance analysis, and maintains continuity of care documentation across healthcare providers.


Required Permissions

Users must have appropriate permissions within the EMS module to access and complete billing and outcomes documentation. Required permissions typically include:

  • EMS module access permissions
  • ePCR completion permissions
  • Billing information documentation permissions
  • Outcomes tracking permissions
  • External reporting permissions

Contact your system administrator if you cannot access specific sections within Billing, Outcomes & External Reporting.


Video




Step-by-Step Guide


1. Inside an ePCR, Click on Billing, Outcomes & External Reporting.


Inside an ePCR, Click on Billing, Outcomes & External Reporting.


2. The Consumables section of Billing, Outcomes & External Reporting is used to document any consumable items and quantities used on an incident. Select the ADD button to document what Supply Items were used, the quantity and the select Save.


The Consumables section of Billing, Outcomes & External Reporting is used to document any consumable items and quantities used on an incident. Select the ADD button to document what Supply Items were used, the quantity and the select Save.


3. Click on Billing.

  • The Billing section of Billing, Outcomes & External Reporting gives the user the ability to capture billing information for the incident. The following are included in the Billing section:

    • Primary Payment Method* - The primary method of payment or type of insurance associated with this EMS encounter.

    • Transport Type* - Non-Emergency, Scheduled Non-Emergency, Unscheduled, Under direct care of a physician, other. 

    • PCS Form - Indication of whether a physician certification statement (PCS) is available documenting the medical necessity or the EMS encounter. If yes, the following are required:

      • Date PCS Signed - The date the Physician Certification Statement was signed.

      • Signed by - The type of healthcare provider who signed the Physician Certification Statement.

      • First Name of Signature - The first name of the healthcare provider who signed the Physician Certification Statement.

      • Last Name of Signature - The last name of the healthcare provider who signed the Physician Certification Statement.

      • Copy of PCS - A digital copy of the PCS form.

    • Response Urgency - The urgency in which the EMS agency began to mobilize resources for this EMS encounter.

    • Patient Transport Assessment - Documentation of the patient's transport need based on mobility and/or physical capability.

    • Specialty Care Transport Care Provider Type - Documentation to show the patient care provided to the patient met the Specialty Care Transport Base Rate requirements.

    • Ambulance Transport Reason - The CMS Ambulance Transport Reason Code for the transport.

    • Round Trip Purpose Description - Description providing the purpose of the round trip EMS transport.

    • Stretcher Purpose Description - Documentation providing the reason for use of a stretcher in the EMS patient transport.

    • Ambulance Conditions Indicator - Documentation indicating the condition(s) requiring an ambulance.

    • Mileage Closest Hospital - The mileage to the closest hospital facility from the scene. Documented only if the patient was transported to a facility farther away than the closest hospital.

    • ALS Assessment Perform Warranted - Documentation that the patient required an ALS assessment and it was performed.

    • CMS Service Level* - The CMS service level for this EMS encounter.

    • CMS Transport Indicator - The CMS Ambulance Fee Schedule Transportation and Air Medical Transportation Indicators are used to better describe why it was necessary for the patient to be transported in a particular way or circumstance.

    • Reason for Physician Certification Statement - The reason for EMS transport noted on the Physician Certification Statement.

    • Transport Authorization - Prior authorization code provided by the insurance carrier/payer.

    • Prior Authorization Payer - The Payer who has provided the Prior Authorization Code.

    • Payer Type - Payer type according to X12 standard.


Click on Billing


4. EMS Condition Codes can also be documented in this section. Select the Add button to add a new entry.


EMS Condition Codes can also be documented in this section. Select the Add button to add a new entry.


5. The Area, Location and Finding fields will offer options for selection and the EMS Condition Code field will allow searches for a Mediation code or name lookup.


The Area, Location and Finding fields will offer options for selection and the EMS Condition Code field will allow searches for a Mediation code or name lookup.


6. Once all information has been entered, click on Save.


Once all information has been entered, click on Save.


7. The Outcome section of Billing, Outcomes & External Reporting documents patient outcomes. This section includes the following:

  • Emergency Department Disposition - The known disposition of the patient from the Emergency Department (ED).

  • Hospital Disposition - The known disposition of the patient from the hospital, if admitted.

  • Hospital Admission Date & Time - The date/time the patient was admitted to the hospital.

  • Hospital Discharge Date & Time - The date/time the patient was discharged from the hospital.

  • Neurological Outcome Hospital Discharge - The level of cerebral performance of the patient at the time of discharge from the Hospital.

  • Outcome at Hospital Discharge - The patient's functional status at time of hospital discharge.

  • Emergency Department Chief Complaint - The patient's reason for seeking care or attention, expressed in the terms as close as possible to those used by the patient or responsible informant.

  • First ED Systolic Blood Pressure - The first recorded Emergency Department Systolic Blood Pressure.

  • Total ICU Length of Stay - The total number of patient days in any ICU (including all ICU episodes).

  • Total Ventilator Days - The total number of patient days spend on a mechanical ventilator (excluding time in the operating room).

  • Emergency Department Recorded Cause of Injury - The documented cause of injury from the Emergency Department record.

  • Hospital Diagnosis - The hospital diagnosis of the patient associated with the hospital admission.

  • Emergency Department Diagnosis - The practitioner's description of the condition or problem for which Emergency Department services were provided.




8. In the Outcome section, Hospital and Emergency Department Procedures can also be documented. Select Add to document new procedures.


In the Outcome section, Hospital and Emergency Department Procedures can also be documented. Select Add to document new procedures.


9. The External Reporting section of Billing, Outcomes & External Reporting allows external reports to be identified or attached to the ePCR. Select the Add button to include an external report.


The External Reporting section of Billing, Outcomes & External Reporting allows external reports to be identified or attached to the ePCR. Select the Add button to include an external report.


10. Select the External Report ID/Number Type.




11. Enter the External Report ID/Number and attach the report, if applicable. Then select Save.





Best Practices

Do:

  • Complete all required fields to ensure proper reimbursement processing
  • Document consumable usage accurately for cost tracking
  • Follow up on patient outcomes when information becomes available
  • Attach relevant external reports that support the patient care documentation
  • Use standardized codes and terminology for consistency across reports

Don't:

  • Guess at outcome information - document only verified patient outcomes
  • Attach sensitive patient information without proper authorization
  • Forget to save entries after completing each section
  • Use non-standard abbreviations or terminology in billing documentation

Troubleshooting & FAQs

Q: Why are some billing fields marked as required? A: Required fields are necessary for CMS compliance and proper reimbursement processing. These fields must be completed before the ePCR can be finalized.

Q: How do I know which consumable items to document? A: Document all supplies, medications, and equipment used during patient care that have associated costs.

Q: What should I do if I don't have patient outcome information? A: Complete the fields with available information and update the record when additional outcome data becomes available through follow-up processes.

Q: Can I attach multiple external reports to one ePCR? A: Yes, you can add multiple external reports by repeating the process for each report that needs to be referenced.

Q: How do I search for specific condition codes? A: Use the search functionality in the EMS Condition Code field, which allows searches by both code numbers and condition names.


Additional Considerations

Billing Compliance Requirements

Ensure documentation meets:

  • CMS billing guidelines and requirements
  • Insurance carrier specifications
  • State and local billing regulations
  • NEMSIS compliance standards

Quality Improvement Applications

Use outcomes data for:

  • Patient care quality assessment
  • Performance improvement initiatives
  • Clinical protocol evaluation
  • System-wide outcome tracking

Revenue Cycle Management

Proper completion supports:

  • Timely claim submission and processing
  • Reduced claim denials and rejections
  • Accurate reimbursement calculations
  • Audit trail documentation

Integration Considerations

This section supports integration with:

  • Billing and revenue management systems
  • Hospital information systems
  • Quality reporting databases
  • External regulatory reporting systems

Documentation Standards

Follow established protocols for:

  • Standardized terminology and coding
  • Timely completion of outcome follow-up
  • Secure handling of external report attachments
  • Consistent data entry practices across personnel


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