EMS Medical Billing; What to Know

As an integral part of public health and safety, Emergency Medical Services (EMS) include first-line emergency medical care for patients. Medical billing for EMS can be more complicated than other healthcare industries, leading to frequent denials and delayed reimbursements. Maintaining a healthy EMS revenue cycle requires a strong understanding of the intricacies of EMS medical billing. 

What Services Are Included in EMS Medical Billing?

EMS medical billing involves every component of emergency medical services, including dispatch, personnel, ambulance transportation, fire departments, and hospitals that operate conjunctly with these services to provide emergency care. EMS personnel include emergency medical responders (EMRs), emergency medical technicians (EMTs), advanced EMTs (AEMTs), paramedics, intensive care nurses, and EMS medical directors.

To simplify, most EMS services fall into three main groups:

• EMS agencies that respond to 911 emergencies, with or without transport
• EMS agencies that provide scheduled medical transport (otherwise referred to as non-emergent transport)
• EMS agencies known as specialty care transport that provide interfacility transport from one healthcare facility to another

Emergency medical transportation is considered the base of medical billing and coding for EMS. Any time this transportation is used, a service fee is charged. Typically, these charges are included in the premiums patients pay through private insurance companies, Medicare, and Medicaid. This means if the patient has health insurance, the fee is billed to the insurance organization. 

With a private insurance agency, patients may have to pay a deductible or co-pay if there’s a difference in coverage. In some cases, patients might not need to pay this difference if they’re a resident. However, a non-resident will have to cover the remaining balance. 

What Are Some Common Mistakes Made in EMS Medical Billing?

Medical billing and coding for EMS gets complicated with the complex regulations set forth by The Center for Medicaid and Medicare Service (CMS). Submitting claims that are accurate and compliant with these regulations is difficult to manage. Frequent denials, poor reimbursement rates, inefficiencies, and inconsistent cash flow are commonly seen with the unique challenges EMS medical billing brings. 

Common errors seen with ambulance billing typically involve:

• Fee schedules. Under Medicare, a national fee schedule exists that applies to all ambulances. This schedule is complicated and changes frequently, leading to errors in charges, and eventually, denied claims.
• Coding errors. Ambulance charges are reimbursed once insurance companies, Medicare, and Medicaid deem emergency medical transportation necessary. This is determined through a specific coding system called the International Classification of Disease (ICD) code. Mistakes are easily made if staff members aren’t adequately trained and qualified in the ICD coding system.
• Procedural errors. Medical staff aren’t typically well-versed in EMS medical billing software and the guidelines set forth by insurance, Medicare, and Medicaid, leading to procedural errors and delayed reimbursements.

It’s important to have a comprehensive understanding of EMS medical billing and coding, insurance, and Medicaid and Medicare services to avoid these common mistakes and maintain a low denial rate and healthy revenue cycle.

How Can Outsourcing Your Medical Billing Help Your Facility?

EMS medical billing brings unique challenges that, if incorrectly managed, can lead to an unsustainably high denial rate and financial loss—jeopardizing the growth of your EMS organization. EMS billing done right requires expertise that medical personnel don’t often have. Outsourcing your medical billing allows your facility to thrive by leaving the complexity of EMS medical billing to the experts. This way, your facility will sustain greater financial health and your team can focus on what’s most important—your patients.

How to Avoid EMS Claim Denials

To obtain a successful billing process, these factors must be handled efficiently:

• A robust pre-billing system to ensure insurance verification before submitting a claim
• Proper coding identifying the services provided
• A structured billing procedure and collections process
• Consistent efforts to stay up-to-date and compliant with changing CMS regulations
• Proper EMS medical billing software that provides data analytics to track workflow and measure success
• Expert management and analysis of your EMS medical billing procedures to establish an overall healthy revenue cycle

It’s crucial to understand each of these factors in the EMS medical billing process to avoid claim denials and maximize reimbursement and revenue. 

Questions About EMS Medical Billing? Contact an Expert at Coronis Health Today!

Coronis Health has over three decades of experience in providing expert EMS medical billing services to achieve a higher reimbursement rate and improve EMS revenue cycle. Our team of certified medical coding and billing professionals utilize cutting-edge EMS medical billing software and provide customized, transparent reporting, so you can be sure your facility is in great hands. We understand the complexity of EMS medical billing and stay abreast of the latest regulation changes, so you can focus on patient care.

Contact us today to learn more about what Coronis Health EMS medical billing services can do for your team and take advantage of our free financial health check-up that finds missing revenue in 95% of cases.

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