In an EMS reimbursement cycle, there is always a disparity between the amount billed and collected for an ambulance run. That happens because of allowances, reimbursement variations by payer, and write-off policies.
What is billed?
When partnering with an EMS agency, a billing company understands the types of write-offs the agency wants to activate. These write-offs influence the billing process.
An EMS claim generally represents the gross charges minus active write-off policies, such as Resident or Membership.
However, there are exceptions.
Hospital District-based EMS providers, unlike fire-based, municipal, or emergency services districts (ESD), commonly have active contracts with different commercial insurance. In these scenarios, the EMS claim reflects what is informed in the patient’s EOB – or Explanation of Benefits. Fire Department-based, municipal, or ESD EMS agencies are usually unaffected by this because they typically don’t contract directly with commercial insurance providers.
What is collected?
If EMS billing is done correctly, a 100% collection rate is impossible. This simple affirmation demonstrates that collection rate isn’t the best metric for EMS billing performance. Collection rate is too easily manipulated due to the factors listed above that affect the billed rate, as well as the varying adjudication timelines across payers.
Besides accounting for write-offs during the billing cycle, the reimbursement process is also affected by Contractual Allowances, Bad Debt Allowances, and Patient Negotiated Discounts.
Although EMS claim charges are usually higher than the pre-negotiated fees, the subtractions can weigh on one’s budget. That’s why opting for an EMS billing company that acts more than just in the revenue cycle – but also as a financial advisor is essential.
With our value-added services, EMERGICON’s experts evaluate and recommend fee schedules, track and analyze reimbursement data, and educate on opportunities to increase revenue. Contact our EMS & Client Hotline for more information: 866-839-3671 | support@emergicon.com.