The quality and delivery of Fire ambulance EMS are being threatened today, hugely because of the ongoing economic crisis. The survival of EMS companies is at stake today.
Top 4 challenges faced by fire ambulance EMS:
1. Poor funding
For quality services from an EMS company, a significant amount of investment is needed. EMS companies acquire huge portions of their funding from Medicaid, Medicare, patients, and insurance companies. They rely on reimbursements and tax support from the locals. Voluntary EMS companies depend on donations from the public. Some depend on funding from selling memberships to support their services. Municipals also have decreased their funding because of budgetary shortfalls.
2. Varying levels of reimbursements
There is a decrease in funding from a fee-for-service reimbursement system and from insurance companies. Many unemployed people in the US are not covered by health insurance. As they are not covered by insurance, they have to pay for their own costs for Emergency Medical Service. This results in the collection of a very small percentage of fees from these patients. Medicare supports ambulance services throughout the US.
ALS or BLS services are the most expensive of all services that are offered by EMS companies. As a result, they are being reimbursed at a higher rate. Many EMS companies charge their Medicaid, Medicare, and uninsured clients, a rate which includes the cost of unreimbursed care. This can result in lower reimbursements from commercial insurance companies.
3. Expensive billing options
The rules and regulations that are involved, while filing services with Medicaid and Medicare, are changing at a rapid rate. EMS companies could resort to outsourcing of the billing and collection services from companies that specialize in these services. 7-10 percent of the collection goes towards paying off the billing companies.
This increases the collection rates. The EMS companies that do not outsource the billing and collection services need to allocate proper, adequate resources. This requires additional compliance to match the rules and regulations of various payers’.
4. Unique coding requirements
Coding standards are applicable for EMS companies. These codes are provided by updates from Medicare. Once the EMS confirms that it was “medically necessary” to provide transport, the insurance companies and Medicare provide reimbursement against transportation. The staff needs to be trained to use the correct codes to avoid fraudulent claims.
Many EMS systems have had to redesign their services to increase their competence and response times, keeping in mind the available funds. Obamacare or the Affordable Care Act (ACA), will have an increase in the public and private sector insurance coverage. It will also ensure a better healthcare delivery system. Much remains to be seen!