Denied and Downcoded Ambulance Claims from Incomplete PCRs

$50,000–$250,000 per year in avoidable denials, recoupments, and risk of penalties from systemic noncompliance with documentation requirements, plus internal audit and remediation costs. • $50,000–$250,000 per year in avoidable write-offs, underpayments, and increased cost-to-collect on self-pay accounts caused by weak PCR documentation that cannot defend billed charges. • $50,000–$250,000 per year in denied and downcoded ambulance claims across the agency due to insufficient narrative, missing times, mileage, and signatures on PCRs that cannot substantiate medical necessity or billed level of service.

Compliance Officer samples charts using ad-hoc queries and Excel lists, manually cross-references billing outcomes, prepares corrective action plans and education memos, and maintains separate spreadsheets to track repeat offenders and high-risk documentation categories. • EMT uses checkbox-heavy ePCR screens with minimal narrative, relies on canned phrases from prior calls, then later responds to billing or QA requests via email or phone to add late notes or corrections after denials or questions from patients about large self-pay bills. • Medical Director or designees pull random charts into PDFs, annotate them, keep personal spreadsheets of documentation issues, and send feedback via email or in-person meetings, trying to manually coach crews on better medical necessity documentation.