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Two Key EMS Reimbursement Strategies

by Jack Donahue on February 14, 2018 at 4:01 PM


Technology companies in the EMS industry have traditionally concentrated their resources on developing innovative solutions and services that help EMS agencies focus on delivering life-saving care. While a significant amount of work has centered on creating efficiencies in response planning, revenue cycle management (RCM) service offerings have become more essential to clients today than ever before.

Patients are continuing to steadily utilize EMS, and costs to provide services are persistently increasing. Factors contributing to financial pressures include the repeal of the insurance mandate decreasing the number of people with insurance, rapid growth of high deductible plans that shift collection activities from the insurance company to the patient, the increase in Medicare and Medicaid HMO insurance with very high copays and deductibles to be collected from the patient and payers increasingly putting pressure on providers to contract at lower reimbursement levels. As a result, EMS agencies’ operational budgets are constrained.

EMS RCM companies are playing an instrumental role in helping providers understand and improve their overall operational/financial health. It is important that EMS agencies and their RCM partners work together to utilize the following tactics that ensure the receipt of maximum compliant reimbursement, and at the same time help the patient resolve his or her financial responsibility.

Supporting Collection Initiatives While Maintaining Positive Relationships with Patients

Following a traumatic 9-1-1 event, the best patient RCM experience is being able to resolve financial responsibilities—without having to involve the patient in the collection process. Considering the nature of EMS, where there is no registration desk in the back of the ambulance for the receipt of patient insurance and demographic information, this is a lofty goal. At Intermedix, a statistic we frequently share is our team’s ability to fully resolve 39 percent of accounts without ever having to contact the patient.

Tools like patient insurance and demographic databases, patient deductible monitoring solutions, insurance follow-up programs, outbound patient call campaigns, payment arrangement options and strategically designed patient statements are several that help support the collection activities for EMS agencies. These techniques are also providing patients with the best overall experience possible.

Ensuring the Appropriate Documentation Occurs

Thorough documentation needs to take place to substantiate why an ambulance transport was needed and why services were performed. The level of detail included has a direct impact on reimbursement, and agencies must practice clear, concise, complete and accurate documentation. Any error or inaccuracy in documentation has the potential to expose an agency to fraud allegations.

Every time a transport occurs, EMS agencies must make sure their crew members are gathering important information such as patient insurance and demographic information, medical history, assessment information, signatures, and more.

While efficient and effective emergency care will always be the top priority in EMS, RCM is critical for the conservation and enhancement of these services. It is therefore necessary for EMS RCM companies to continue to identify alternate revenue sources and help boost reimbursement for clients in support of their noble mission.

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This post was written by Jack Donahue

Jack Donahue is the Executive Vice President of EMS at Intermedix. Prior to joining Intermedix, Jack is the Senior Manager at Arthur Anderson. Jack holds a bachelor’s degree in Business Administration from the University of Notre Dame. He also holds both a Master of Business Administration and an Executive Masters in Health Administration from the University of Florida.

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