Understanding EMS Billing

Also known as ambulance or paramedic services, Emergency Medical Services (EMS/EMAS/EMARS) is the service used in case of an immediate medical requirement. It is especially dedicated to providing out-of-hospital acute medical care and providing transport to patients who are critically injured or ill and cannot transport themselves.

These services are also known as ambulance/emergency/rescue/first-aid or life squad/services. It’s important to have a comprehensive understanding of EMS billing and coding, insurance, Medicaid, and Medicare services to avoid common mistakes and maintain a low denial rate and healthy revenue cycle.

EMS uses specially trained people (e.g. paramedics) and equipment to provide immediate medical assistance to a patient who might need it at home before being transported to the emergency room of a hospital. In addition, EMS provides inter-facility transport. EMS also constitutes of emergency medical technicians (EMTs) who do precise rescue jobs and answer calls.

The entire EMS system comprises private and public organizations, communication and transport networks, hospitals and rehab centers, physicians, nurses, administrators, government officials, and the public who knows when to call whom. EMS also works with fire and law enforcement services. But the most important is the ambulance organization.

EMS Billing

Like other services, EMS requires billing too. For any calls for assistance, non-transport disregard, or usage of ambulance transportation (paramedic or EMT) to a hospital facility, a service fee is charged. This fee for medical transportation is usually included in the premiums that people pay for their insurance through a private organization/Medicare/Medicaid (insurance premiums are driven by drugs, research, and technology and include the EMS costs).

These services are usually billed to the insurance payer (Medicare, Medicaid) when a patient uses the ambulance transportation facility to a local emergency room and has health insurance. For a private insurance agency, the patient might have to pay a co-pay or deductible and/or if there is a difference in coverage. In some cases, if the insurance does not pay the full amount, the patient does not have to pay the difference (residency status).

But in the case of non-residents, they need to pay the difference. Again, if the resident does not have insurance, the bill could be written off after verification. All other non-residents will be responsible for co-pays and deductibles. According to caldwellcountync.org, ‘The EMS Billing Department follows the Centers for Medicare and Medicaid Services (CMS) “Fee Schedule for Payment of Ambulance Services” as described in Volume 67, Number 39 of the Federal Register.’

The billing process is quite simple. A form is filled out by the resident (patient) which allows the hospital facility to bill the insurance provider for the services rendered. If the patient is unable to sign, the ambulance crew and the hospital staff sign the bill to confirm the transportation. And a fire truck, which comes with an ambulance, is not charged. Sometimes, the patient’s protected health information (PHI) could be used for taking payments/charges for an ambulance.

The funds from EMS transport billing are used in EMS and for operations of the fire-rescue department. Integrated with other services, EMS is designed to uphold and enhance the health and security of the community.