Why Collection Rate Isn’t the Best Metric for EMS Billing Performance

Why Collection Rate Isn't The Best Performance Metric

If you’ve had any conversations about billing for ambulance services or Emergency Medical Services (EMS), you have likely heard about tracking your collection rate. But before you make any decisions, here are some things you should know about collection rates.

If EMS billing is done correctly, a 100% collection rate is impossible.

The collection rate begins with an EMS agency’s fee schedule, the list of charges that an EMS agency assess for different types of responses and transports. When setting a fee schedule, EMS agencies should focus on capturing as much revenue as possible from commercial payers, like private insurance. However, government payers like Medicare and Medicaid, have pre-negotiated fees for services. The difference between what the agency charges and what Medicare and Medicaid will pay is called a Contractual Write-off. The Contractual write-off immediately reduces an agency’s collection rate.

Reimbursement timelines are longer.

With the shortest reimbursement for an EMS claim being two (2) weeks, it is often a misrepresentation to view a collection rate monthly. Fees charged within a month are rarely recouped within that same month, so collection rates based on a single month’s period are often not truly reflective of the larger collection efforts.

So, if collection rate doesn’t help me measure EMS billing performance, what does?

Cash Collections or Cash Per Transport

The best way to truly see if your EMS billing efforts are successful is to track total cash collections per month or cash per transport (cash collections in each period divided by the number of transports in that same period).

When you are looking at cash in the door, or subdividing that number into cash per transport, you can much more reliably see which direction your cash is trending.

If you’d like to keep this conversation going, please reach out to us at! We’d love to talk to you about how we can improve the metric that matters, your cash per transport!

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