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Specialized Billing for Emergency Medical Services
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
EMS Medical Billing Services We Offer
Emergency medical services (EMS) billing is distinct from medical billing. Also known as ambulance billing, EMS billing includes submitting trip sheets and using destination modifiers for accurate and timely reimbursements. Broadly speaking, it is the process of collecting reimbursement for transporting a patient to a nearby medical facility or hospital via an ambulance, helicopter, fire engine, or police vehicle while administering the necessary pre-hospital care to stabilize the patient’s critical condition.
Medicare, Medicaid, and private insurance companies cover emergency medical services. Still, the claim denial rate is high for EMS providers. At MediBill MD, we streamline the billing workflow, automate the processes, and use industry best practices to improve the first-pass claim submission rate for EMS claims. Our EMS billing services include complete documentation and correct coding for swift collections and an increased bottom line.
Common Challenges in EMS Billing
Emergency medical services are of various types, ranging in complexity and offering an array of solutions depending on the patient’s needs and the difficulty in accessing his location. From basic life support (BLS) to advanced life support (ALS) and critical care transport (CCT), several transport options are available, such as single-person ambulances, paramedics, and air ambulances/helicopters, to safely transport injured, ill or deceased persons to nearby hospitals or medical facilities.
The numerous challenges that emergency medical service staff encounter on the ground must be reflected in the EMS claim filing for rightful reimbursements. However, several EMS systems cannot capture accurate charges, apply the correct codes and modifiers, and provide sufficient documentation for seamless claims processing. Understanding and navigating the challenges in EMS billing is the first step toward denial prevention.
Coding Confusion
Untrained in-house coding and billing staff may not be familiar with the code sets specific to EMS billing. Billing for emergency medical services involves reporting accurate codes and appending the appropriate modifiers. However, this can quickly become challenging with frequent revisions in the coding systems and guidelines.
Insufficient Documentation
The documentation requirements for EMS billing and reimbursements are very different from medical billing for other specialties. Along with basic supporting documents, EMS providers must submit trip sheets, a signed Physician Certification Statement (PCS), and a detailed Patient Care Report (PCR) narrative to explain the medical necessity of EMS.
Late Claim Submission
In most cases, the EMS claim submission deadline varies between 180 and 360 days. However, documents like the PCS must be obtained within 21 days from the date of service for the claim to be valid. Moreover, the claim filing deadline may differ from payer to payer. So, missing the deadline or submitting invalid paperwork results in claim denials.
Miscommunication
In cases where several emergency medical services reach the location to provide pre-hospital care and transportation to the patient(s), miscommunication can cause a conflict on who will get the reimbursement. By law, only the service that transports the patient to the hospital is eligible for payment. However, without communication, payment disputes arise.
Outsourcing EMS Billing Services to MediBill MD
The job of emergency medical services is to be the first ones to respond to emergencies, reach inaccessible locations, provide urgent treatment and stabilization, and safely transport the patient(s) to a hospital for comprehensive medical care - NOT to spend hours capturing charges, coding services, and processing claims. Outsourcing EMS billing services to reliable third-party medical billing companies ensures accurate and timely claim submission, 100% regulatory compliance, effective denial management, and faster payment collection.
MediBill MD is a proven EMS billing company that comprehends the unique nature of emergency medical services billing. Its specialized team of certified coders and billers stays up-to-date with changing policies and billing guidelines, effectively tailoring the solutions for compliance and clean claim filing.
At MediBill MD, we employ a diverse team of AAPC-certified coders who have adequate industry experience and a deep understanding of billing for emergency medical services. They are proficient in using the appropriate CPT, ICD-10, and HCPCS codes for procedures, diagnoses, and supplies while appending the correct origin and destination modifiers.
Whether your claims are addressed to Medicare, Medicaid, or a private health insurance company, we can handle their specific billing requirements and reimbursement guidelines. Our EMS billing team carefully studies the payers’ policies and contract terms regarding EMS coverage and reimbursement rates to file compliant claims.
A majority of payment disputes arise because of miscommunication between the provider, patient, and payer. At MediBill MD, we act as a bridge, maintaining efficient communication between the EMS provider, patient, and insurance payer to detect discrepancies in information, ensure clean claim submission, and prevent denials.
We combine human expertise with advanced technology to streamline the EMS billing workflow while maintaining premium quality in all our deliverables. Our automated data entry, medical coding, and claim scrubbing tools ensure that every electronic claim submitted to the payer is error-free and complete.
Offering instant expert aid for severe billing crashes! It does not matter where your practice is located within the country. We can be the first ones to reach you when your finances hit rock bottom. Our end-to-end EMS billing solutions are available 24/7 throughout the country, ensuring you receive state-specific, results-oriented, compliant, and timely service for your unique billing needs. Choose us to keep America’s EMS system stable!
Overcome EMS Billing Challenges with MediBill MD
From incorrect coding to missing modifiers and incomplete documentation to non-compliance with the payer’s billing guidelines, several mistakes can derail your EMS billing process, preventing you from collecting the compensation you deserve for your timely acts of valor. At MediBill MD, we recognize your efforts, and our EMS billing solutions are designed to capture every dollar for the work you have put into saving lives.
| Common EMS Billing Challenges | MediBill MD Solution | |
|---|---|---|
| Incorrect or Missing Origin and Destination Modifiers | Our team appends the correct origin and destination modifiers with every medical claim for an ambulance service to capture the right payment amount and avoid denials. | |
| The EMS Service Level Does Not Match Provider’s Credentials | The provider’s credentials must match the EMS service level he offered. E.g., a licensed paramedic must be on board an ALS transport to monitor cardiac activity. Our team ensures that. | |
| Various Payers | Different types of patients mean various insurance companies and their specific requirements. Our urgent care billing team strives to stay current on ever-changing payer guidelines to ensure faster payments. | |
| Incomplete Documentation (For example, missing trip sheets, physician certification statements, and patient care reports) | Complete documentation is required to prevent claim denials. Our EMS billing team gathers the required paperwork and ensures the entered information is consistent to avoid payment delays. | |
| Inefficient Call Intake and Dispatch Process | Staff at EMS systems often don’t obtain correct and complete information during calls and dispatch, making claims processing difficult. Our team verifies all the information by double-checking patient records. | |
| Not Proving Medical Necessity for Ambulance Transportation | Insurance payers deny the claim when the provider cannot prove the medical necessity of an EMS. We collect all the evidence, like lab reports, clinical notes, and physician certifications, to prove its need. | |
| Not Obtaining a Written Order and Certification Within 21 Days from the Date of Service. | We follow Medicare’s rule for ambulance billing and ensure that a physician’s written order and certification are signed and obtained within 21 days from the service date for clean claim submission. | |
Lowest Prices Guaranteed
Unmatched expertise and unparalleled quality at unbeatable monthly rates! Get our all-inclusive EMS billing services at a small percentage of your net monthly collections. Ready to rediscover the science of affordable and error-free EMS billing?
Schedule a Consultation with our
EMS Billing Specialist
We focus on your revenue cycle so you can focus on the community’s health and safety. Contact our EMS billing team to get free expert advice and a service demo.
