Accessibility is a major issue that directly affects patient outcomes in the healthcare system. When getting the treatment they need, those who are disabled or have particular medical requirements often rely on Non-Emergency Medical Transportation (NEMT) services.
It might be challenging for a transportation company to offer NEMT billing and reimbursement services due to the complexity of the industry.
However, your company’s financial performance depends on your familiarity with the nuances of MTM NEMT billing. To help you improve your operations and increase your revenue, this tutorial will examine the essential components of MTM NEMT billing.
What is MTM NEMT Billing?
Billing for non-emergency medical transportation services supplied to Medicaid patients eligible through the MTM (Medical Transportation Management) system is referred to as “MTM NEMT billing.”
MTM is a well-known NEMT service provider with locations all throughout the United States. Partnering with MTM as a transportation provider helps you reach Medicaid patients who rely on NEMT to go to their doctor’s visits, hospital stays, and other healthcare industry needs.
Understanding Medicaid Guidelines
Successful MTM NEMT billing requires an in-depth familiarity with Medicaid regulations. Medicaid is a federal-state partnership that helps low-income families pay for medical care.
The Medicaid program is administered statewide, although all states must follow federal rules and regulations. To guarantee compliance and maximize reimbursement, you should study the Medicaid criteria of the state(s) you offer NEMT services.
Eligibility and Prior Authorization
Medicaid recipients’ eligibility and previous authorization must be confirmed before any NEMT services can be rendered. Medicaid programs across the country have different eligibility requirements.
In most cases, to get NEMT services, recipients must first meet certain health and income thresholds. To prevent claim denials, transportation service providers must verify eligibility and obtain prior authorization from MTM or the appropriate Medicaid agency.
Documentation and Record-Keeping
Correct and thorough documentation is the backbone of profitable MTM NEMT billing. To file valid claims and ensure adequate compensation, keeping detailed records of each transport given is crucial.
Date, time, pick-up and drop-off locations, the reason for the vehicle (e.g., medical appointment, dialysis treatment), and name of transport recipient are all crucial pieces of evidence. Also, any deviations from the norm for transportation services must be documented for accurate billing.
Coding and Billing Procedures
MTM NEMT billing revolves mostly around the coding and billing processes involved. The appropriate billing codes must be used to appropriately reflect the services rendered. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes are frequently used in NEMT billing.
Verify that you are well-versed in your state’s MTM- and Medicaid-accepted codes. To prevent claim rejections and delays in reimbursement, it is crucial to properly document and code each transport service.
Claims Submission and Reimbursement Management
It is time to submit your claims for reimbursement once you have gathered all the required documents and correctly tagged the services. Transportation providers are required to adhere to a specific methodology for submitting claims to MTM.
Learn the ins and outs of the submission process, such as the necessary documents and online tools. Claims must be submitted on time if timely reimbursement is to be achieved.
The Medicaid program in your state will generally set reimbursement rates for NEMT services. It is crucial to know the rates at which services are reimbursed and whether or not they are subject to any limits. Make sure you are billing correctly and making the most money possible by reviewing reimbursement rates on a regular basis.
Claim Denials and Appeals
A claim may be rejected despite your best efforts. Inadequate or incorrect documentation, lack of prior authorization, coding problems, or exceeding the monthly trip limit are common causes of denials. When a claim is rejected, it is essential to investigate the cause of the rejection and take corrective measures.
This could entail fixing coding mistakes or setting the denial by submitting new supporting evidence. Your transportation company’s optimal income and financial stability depend on your swift response to claim denials.
Compliance and Audits
Keeping the alliance strong and protecting against audits requires adhering to MTM’s principles and procedures. In order to ensure that services are being priced correctly, MTM may do audits.
In order to pass an audit, it is essential to keep detailed records and follow all applicable criteria. Policies and procedures should be reviewed regularly to reflect any shifts in MTM’s expectations or Medicaid rules.
The MTM Advantages
MTM has worked with clients successfully to handle NEMT for over 20 years, making us a leader in the field. They were the first company to specialize in coordinating different NEMT services when they opened in 1995, and now they are your reliable transportation partner.
MTM assists its customers in making the most of their transportation budgets, allowing them to save as much as 25% on non-emergency medical transportation (NEMT) expenses.
MTM employs data and technology to reduce NEMT program costs and enhance health outcomes for your members, and their 2022 acquisition of Veyo is a big part of that. We are not only a NEMT broker. We collect useful information that will allow you to get the most out of your NEMT funding, and they do this as an integral part of the treatment continuum.
If transportation were consistent and on time, there would be fewer missed visits, better results, healthier members, and higher HEDIS, STAR, and CAHPS scores. This is why they provide easy-to-use tools for users to track their trips in real-time and make reservations.
It can be challenging to keep up with the ever-changing demands of a transportation system. Networks of Independent Driver Providers (IDPs), a Virtual Fleet model that augments traditional networks of commercial transportation provider guidelines with highly qualified.
NEMT-specialized rideshare drivers are part of MTM’s rural and urban networks in more than half of the United States.
The company has the expertise to quickly and efficiently build networks in new locations. With the help of IDP fleets, they can provide services to qualified members across the globe without sacrificing quality, productivity, or affordability.
You can rest easy knowing that your members will be transported safely and securely since we hold all transportation providers, including IDPs, to the highest customer service and safety standards.
All IDPs must complete HIPAA, Sensitivity, and Medical Needs training, ADA education, and CPR certification. For everyone’s protection and the best possible service, they get drug tested and check their backgrounds multiple times.
Technology makes automation, protocol adherence, mistake minimization, and instantaneous data access possible by technology, making it the beating heart of MTM’s operations.
Their goal is zero missed trips, and all of their technology—from MTM Link, their proprietary scheduling platform, to their call mining platform, to the apps, portals, and IVA systems used by their stakeholders—supports this goal.
MTM Link provides stakeholders access to trip scheduling, real-time visibility, and transparency into NEMT performance. They can significantly enhance on-time performance and service visibility using cloud-based, peer-to-peer disp tandem with GPS tracking. But what do these things signify?
Problems like traffic or broken down vehicles are immediately detected by their technology and rerouted accordingly. We use an internal algorithm to forecast daily demand based on past and prospective trip information, utilization patterns, and estimated pick-up times and delays.
Real-Time Data and Insights
Intuitive and easy-to-use dashboards show all aspects of a journey, from planning to routing to member communication to payment to driver evaluations. In addition, they can see each car’s precise whereabouts and travel paths thanks to GPS tracking.
We have the information necessary to answer questions like how successful pre-trip reminders are or where a member was dropped off. With them, you’ll have complete visibility into your transportation benefit, from trip data to expenses, service levels, driver credentials, utilization rates, and member trends.
Knowing the ins and outs of MTM NEMT billing is crucial to the financial health of any transportation company that offers NEMT services.
You can expedite your operations and receive the highest possible reimbursement by learning about Medicaid requirements, acquiring appropriate prior authorization, keeping detailed records, and using proper coding and billing practices.
Remember that maintaining a productive relationship with MTM and avoiding audits requires fast action on claim denials and compliance checks. The information in this manual will prepare you to handle the nuances of MTM NEMT billing and ensure the long-term success of your transportation company.