Mileages

AngelTrack has a sophisticated mileage system that aims to solve the problems caused by "actual mileage" contracts.


The Difficulty of "Actual Mileage" Contracts

Most EMS contracts specify that actual mileage, rather than book mileage, will be charged. This approach is far more equitable than book mileage, because it compensates EMS for the extra miles so often incurred by road and traffic conditions, by diversions, and by patient requests.

Unfortunately, the use of actual mileage raises these problems:

These problems will occasionally result in an angry phone call from a patient, who is looking at MapQuest and demanding an explanation for why the mileage doesn't match.

AngelTrack set out to solve these problems using a statistical system that learns what the normal mileage is for any given route.


Speedometer


The Normal Mileage Statistical System

When crews perform a transport, AngelTrack prompts them to record their starting and ending odometer readings, in order to calculate the Actual Mileage. The Actual Mileage is always printed in the run report, even though it may be wrong on account of a typographical error in the odometer readings, and even though it may be artifically elongated due to a double-load.

This mileage is not immediately claimed during billing, due to the likelihood of typographical errors. First it must be checked and approved by the QA review process.

When it passes QA, the odometer readings are added to the statistical profiles that AngelTrack maintains for each pickup/dropoff point. The mileage and the travel time are rolled into the moving averages that are constantly updated for trips between any two points.

The moving averages are pre-loaded with seed data from Google Maps. They then accumulate additional data from every trip run by EMS.

As the statistical database grows, it begins to inform the billing process. Some transports will run longer (traffic detours, alternate routes, etc.), some will run shorter, sometimes crews type in the wrong odometer readings... all of it is factored in and smoothed over. Over time this moving average will come to accurately reflect the real driving distance between A and B. This moving average -- showing the real driving distance -- is called Normal Mileage.

Normal Mileage - Okay

Now suppose a detour occurs, perhaps the extended drive of a double-load. The statistical system irons it out:

Normal Mileage - Double Load

The system protects both EMS and the customer from these mileage excursions... but at the same time, if mileage excursions are the norm (perhaps owing to a permanent detour caused by road construction), then the statistical system will self-adjust, and EMS will be properly compensated for the extra mileage.

It is not perfectly fair, but it is nevertheless more fair to both parties than the alternatives... and it is entirely automatic.

"What if EMS takes an intentional detour to pad the mileage?"

The Normal Mileage system in AngelTrack protects the patient against occasional detours -- whether appropriate or not -- because the patient will be charged only for the typical mileage for the trip.

The system does not protect against an EMS company that takes unnecessary detours on every trip. This kind of fraud is an eternal problem in the taxi industry... however it is not a significant problem in EMS simply because an EMS service makes most of its money on the pickup, not on the mileage.

Consequently, it is always more profitable for an ambulance to finish a transport quickly and move on to the next pickup. This is why dispatchers react with such irritation when a crew chooses to take an indirect route owing to traffic or an accident: first priority is always finish the transport and get back in service.

Normal Mileage usage in AngelTrack

Normal Mileage is used many places in AngelTrack...


Declared Mileage

AngelTrack also allows Dispatchers and Billers to specify a Declared Mileage between any points A and B -- that is, from any facility A to any other facility B. The Declared Mileage represents a final judgment on what the real transport distance is between A and B.

If there is a Declared Mileage for a trip from point A to point B, then it overrides both the Normal Mileage and the Actual Mileage throughout the entire billing process.

To set or clear a Declared Mileage for any given route, open its Dispatch Edit page, switch to the "Billing" tab, and input a number into the "Declared" mileage box. You can also clear (delete) the declared mileage for the route by clearing the box and the saving.

Declared mileage can also be checked, edited, and deleted using the facility record for point A or point B. Visit the Facility List, click the desired facility, select the "Runtimes" tab, and find point B in the list of other facilities (the list contains every point B for which AngelTrack has records of a trip from point A). Type a number in the box in the Declared Mileage and hit Enter. That number is now the Declared Mileage for the outbound trip; you can also declare a mileage for the return trip (going back the other direction).

Avoid declaring a mileage unless absolutely necessary

When you specify a Declared Mileage from point A to point B, it automatically trumps any Normal Mileage for the route. It therefore can no longer evolve according to changing roads and road conditions, and so may eventually become inaccurate -- either in EMS's favor or in the customer's favor. Try to avoid this unless a customer -- looking at an online map and unaware of the problem of detours -- specifically demands a certain odometer reading for a route.


Mileage and Insurance Claims

It is up to the biller to decide whether to claim the Normal Mileage or the Actual Mileage when filing against insurance. The biller should understand the pros and cons of each approach before making any such decision.

In the Coding page the biller is shown both values, along with a radiobutton to choose which to claim. A percentage figure is shown, indicating how much the Actual Mileage differs from Normal. If the difference is large, the percentage figure will be highlighted in red. Any significant divergence should be investigated, if there is not already a Billing Note from QA explaining it.

By default AngelTrack will select Actual Mileage, if odometer readings are available; otherwise it will default to Normal Mileage... but of course the biller can change this.

Normal mileage will freeze once claimed against the primary

If you choose to claim Normal Mileage, the then-current value will be captured and saved, so that the same value will be used when filing against secondary insurance later, even if the statistical system has since evolved to a slightly different value. For example, if you file a Normal Milage of 22.7 with primary insurance, then AngelTrack will automatically file 22.7 with secondary insurance, even if the statistical system has since evolved to show 22.8.


Mileage and Invoices

When using the Invoice Generator to produce invoices, the following sources of mileage data (in descending order of preference) are consulted in order to select the most accurate possible mileage for a transport from A to B:

  1. Declared Mileage from facility A to B, if any
  2. Declared Mileage from facility B back to A, if any
  3. Normal Mileage (the statistical moving-average) from facility A to B, if any
  4. Normal Mileage from facility B back to A, if any
  5. Actual odometer readings typed in by the crew (known to be frequently mistyped)

Interaction with prices adjudicated by insurance carriers

When invoicing patients for the copay due on an insured call, the normal mileage is not used. The amount invoiced is whatever copay is set by the insurance carrier during adjudication; contractually, that is all you are permitted to charge.

When invoicing a facility or an affiliate for an insured call, the adjudicated price will prevail, and so the question of mileage is irrelevant. If your contract specifies that contract prices shall override any price adjudicated by insurance, then tick the ☑ Clear any insurer adjudicated prices checkbox when generating the invoice. At that point the normal mileage will be used to calculate the prices according to the contract's price schema.

Read the Invoicing guide to learn more.

This system should be mentioned in your facility contracts

When you ink a new facility contract, you should mention that your invoices will be calculated using the aforementioned statistical system. The following text should suffice:

The billable mileage of each transport shall be calculated by a computer system using a "moving average" algorithm maintained for all pickup/dropoff routes. For each route, the algorithm shall be seeded with the driving distance calculated by Google Maps™. After seeding, the moving average shall float freely as actual driving distances (taken from vehicle odometer readings) are integrated into the data.

The undersigned acknowledges that the mileages calculated by the aforementioned algorithm may differ significantly from the driving distance quoted by Google Maps on any given day. These differences will wax and wane over time owing to traffic conditions, regular detours, and double loading.

Mileage data is stored in the invoices

When an invoice is generated, it captures the best available mileage data for each trip, using the formula shown above. This mileage data is then stored in the invoice, where it does not thereafter change even though the mileage moving averages will continue to evolve and change. In other words, an invoice creates a frozen snapshot of the dynamic mileage data.

The mileage data in the invoice can then be changed by hand (using the Invoice Edit page), along with the prices, but it will not automatically update with newer information from AngelTrack's mileage system.

Disabling normal mileage / Using actual odometer readings

If you read all of the aforementioned, and still want to use actual odometer readings in your invoices, then you can do so.

Visit Preferences under Settings, and tick the ☑ Actual mileage checkbox under "Invoice mileage data" in the "Billing" section. Once that's done, then all new invoices will be constructed from the actual odometer readings. You must then double-check the mileage reading on each item in each invoice, because actual odometer readings are fraught with typographical errors, many of them too subtle for software to catch.



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