ABC’s of Ambulance Billing and EMS Billing

Ambulance Billing Services and EMS Billing Services,  like any other billing process,  really just requires some very basic focus on the right things to insure that payments are made timely. It is easy but critical that no bill which has a chance of being paid somehow goes unpaid. Whether you do Ambulance Billing and EMS Billing in-house, or use an Ambulance Billing Service or EMS Billing Service, the basics of the work do not change.

EMS Billing and Private Ambulance Billing have some obvious differences such as;

  • Multiple payers paying parts of the same bill
  • Fixed amounts to be paid and fixed amounts to accept as write offs
  • EMS departments are usually required to provide service whether they will be paid or not
  • In Ambulance Billing the payer controls what has to be done in order for them to pay 
  • Government programs that simply pay untimely – and you still have to do business with them

In the past decade while consulting in the industry, I often converted clients from older systems to more modern software and/or from older manual processes to more automated processes. I was always surprised and amused at the comments about why the client was not collecting more from their patients and patient’s insurance.  There are undoubtedly valid time constraints when using some software and some manual systems, but this is never a valid reason to not be collecting the maximum.  Almost always the ABC’s highlighted below were simply not followed. And always had the lost revenue actually been collected, it would have justified some additional overhead to obtain those results, either with more personnel or an investment in more efficient software.

So what are these ABC’s or basics of the Ambulance Billing process?  How do you achieve the process that ensures “No bill left behind”?  Whether you do the billing in-house or use an outside billing company, and whether you use modern more automated software or some older less sophisticated software the process and due diligence is the same.  Albeit the time and cost to complete the tasks vary based on the tools used. Efficient software might quickly and easily identify unpaid bills or not timely paid bills. Less efficient software might produce a long list of all open bills and you review and identify them manually. Both will allow you to identify unpaid bills, which is a main steps in the process, albeit slower with one tool versus the other.

The main steps to making sure no bill is left behind unpaid are to ensure the following steps are done timely and every step is done,  repeating the process forever. In my years consulting in the industry, this is usually where every executive, Fire Chief or owner assured me “their biller(s)” do this every time only to discover upon audit that it is not the case.  Often with a quick review of the data of accounts and transports,  unpaid bills were found stuck in limbo and not followed up on.  This results in bills never paid and lost money.  And almost always in my consulting, with a little more due diligence they could have been collected.  Even more of a surprise to management was that the list could be found by me in minutes. Obviously, the software used impacts the level of effort and time to find the records and it is a matter of knowing how to look and what to look for.

The “steps” follow this basic path below, and when done money is significantly improved.  With Private companies doing pre-scheduled transports some of this can be even done before you transport, such as insurance verification and eligibility checking, or credit card payments to prevent unpaid transports, not a luxury of most government EMS departments.

Basic Steps that must be completed;

  • Get all information needed to code and Bill – insurance, EPCR report, Patient information
  • Get Insurance and/or process eligibility checks, and/or use insurance gathering techniques
  • Get that first bill to insurance and/or customer out the door immediately.
  • Verify that the Bill was accepted by payer immediately and/or received by patient.
  • Process and re-file any of the immediate rejects and verify all claims sent were received or rejected and refiled immediately
  • Post Cash and review any denials and rework/appeal and/or move to next payers
  • Use automatic or manual follow up for unpaid claims using a set number of days based on the payer. Example 14-21 days for Medicare, x Days for your states Medicaid, x Days for the top 10 insurance companies where most claims dollars are, and a set amount for any and all others.
  • Run Daily – Weekly – Monthly Audit reports of any and all unpaid bills – by insurance or private pay. Review all follow ups the day they occur and re-bill if needed.  Ensure you have reports that find all claims in “limbo” and resolve the reason they are stuck.  No Bill should ever be stuck for any unknown reason.  At some point it is patient pay – or collections or written off as noncollectable.  Claims sitting pile up and then payable claims in lost in the blank hole of claims unknown – if it is not getting paid ever flag it and remove from your active work list.
  • Analytic’s reports (or spreadsheets if you lack such a tool) that track trends of payments by month – year – trends and analysis of when they vary up and down and determine why, percent of charges versus payments and other trends. Not knowing why cash and payments vary translates to not knowing if there is a way to fix or improve the problem.

In future blogs I will drill down into the details of these steps and expand upon where the ball gets dropped consistently around the country.