Six Core Strengths®: Mastering Compliance in EMS Billing

6 Core Strengths-Compliance

With a relentless commitment to excellence, EMERGICON prides itself on having carved a contagious reputation throughout Texas. From the unwavering dedication to customer service that ensures exceeding expectations to the commitment to compliance in EMS billing that stands as a cornerstone of our business, EMERGICON evolved as a force for good within the ambulance billing industry. This blog series will explore the Six Core Strengths® that set us apart and contribute to our continued success, starting with compliance

What It Is

Compliance, in essence, is the compass that guides industries toward ethical practices, legal observance, and accountability. It ensures obedience to rules, regulations, and standards within different industries. In healthcare, compliance is the guardian of integrity, confidentiality, and accuracy in handling sensitive patient information. It guarantees that healthcare providers, billing companies, and insurers operate following the guidelines of laws such as the Health Insurance Portability and Accountability Act (HIPAA) and Texas Administrative Code.

Through compliance practices, the EMS billing industry protects patient data, prevents fraud and abuse, and promotes transparency in financial transactions. These practices can include appropriate documentation of medical services, precise and timely claim submissions, and meticulous record-keeping for auditing purposes. Upholding compliance mitigates legal and financial risks and contributes to the overall trust and efficiency of the pre-hospital healthcare system, ultimately benefiting patients, providers, and payers alike.

Why It Matters

Nicole Rhone, Director of Compliance

EMERGICON focuses on compliance as a core competency to protect our partner agencies and their patients. According to EMERGICON’s Compliance Director, Nicole Rhone, guidelines for EMS documentation and billing are more stringent than ever before. As a result, EMERGICON’s compliance program focuses on deeply understanding the laws and regulations governing EMS documentation and billing, as well as helping partner agencies remain compliant with the ever-changing guidelines. 

The Department of Health & Human Services published The 7 Fundamental Elements of an Effective Compliance Program, a collection of tips that have informed EMERGICON’s Compliance Program. The Compliance Plan is reviewed regularly by the Compliance Director alongside other company leaders. “Compliance is part of every department in our business. From working with the EMS claims to administrative processes, each team member receives training and follows our compliance guidelines on their work routine,” stated Rhone. 

EMERGICON strives for compliant practices daily. Beyond the continuous investment to train the team on compliance standards at Federal and State levels, some other policies are: having an audit team for internal monitoring and reviews, providing a hotline for anonymous reports of compliance violations (if you see something, say something), and educating partner agencies on the best procedures to complete a Patient Care Report (PCR) and manage patient data.

Take-Aways about Compliance

1. No matter who performs the function of billing for your EMS agency (an internal team, an external partner, or EMERGICON), compliance with laws and regulations should be a top priority for them.

2. As a value-added service, EMERGICON’s compliance department provides holistic documentation reviews, feedback, and tailored education to help partner agencies document their runs more compliantly.

3. Education By The Sea, the annual conference produced by EMERGICON, in association with Port Aransas EMS, is a great annual event to catch up on the latest news in Compliance from Attorney Steve Wirth of EMS law firm Page, Wolfberg & Wirth.

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

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