Patient Data – What It Is and Why It Matters

Patient Data – What It Is and Why It Matters

In this age of increased focus on data security, it can be scary to share personal or private information. If you find yourself in the position of a patient, it’s relevant to know what information is most helpful to those providing care and how it’s used across all groups involved. That’s what we will discuss in this blog.

Patient Perspective

When the EMTs and Paramedics arrive on the scene of a 911 call, the patient is often in a surprising and unwanted situation. Answering many questions while feeling vulnerable can add to that tension. However, providing the data requested by the EMS crew prevents the patient from running into another stress later: a giant unexpected bill and the extra steps of submitting the bill to their insurance provider to get it paid.  

EMS Agency Perspective

In life-or-death runs, the EMS crew focuses on caring for the patient’s needs. Still, completing a detailed Patient Care Report is the first step to a successful EMS claim billing and reimbursement process.

There are some criteria that a PCR must observe to be compliant for EMS claim reimbursement. Read the documentation best practices for Patient Care Reports blog to learn more about that.

Billing Perspective

At EMERGICON, the lifecycle of an EMS claim starts in the Pre-Billing Department. The Pre-Billers are responsible for checking the patient’s data on the PCR and finding their healthcare coverage. 

With accurate and complete patient information, Pre-Billers can find the designated healthcare coverage (MedicareMedicaid, and/or Commercial Insurance) and bill the EMS claim for the correct payer. 

In order to bill the correct payers, Pre-Billers must confirm three original pieces of patient information from the PCR that matches the data found in the insurance’s system. Furthermore, acceptable pieces of information for this process are:

  • Name
  • Date of Birth
  • Social Security Number
  • Address
  • Insurance Member ID 

It is common in some emergent scenarios for PCRs to contain misspelled names or missing information. Aware of the possibility, EMERGICON’s Pre-Billers are trained to detect these situations. Following HIPAA‘s guidelines, they utilize different patient information resources to solve the case and forward the EMS claim to the next step. 

When searching for patient information on these tools, a minimum of three identifiers must match the original PCR to guarantee a compliant process. The preferred identifiers are name, date of birth, address, and last four digits of SSN. If unable to match three items from this list, the patient’s Driver’s License or Phone Number can be used as additional information.

Patient data should always be protected and used only in secure ways. Nonetheless, as you can see, it’s invaluable to EMS providers and those processing their claims.

If you have any questions, contact EMERGICON’s teams through our EMS & Client Hotline: 866-839-3671 |

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