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Understanding EMS Billing

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.

Contact us today to learn more about what Medical Billers and Coders (MBC) 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.

FAQs

Q: What are Emergency Medical Services (EMS)?

A: EMS, also known as ambulance or paramedic services, provides out-of-hospital acute medical care and transport for critically injured or ill patients who cannot transport themselves.

Q: Who provides EMS?

A: EMS services are delivered by specially trained individuals, including paramedics and emergency medical technicians (EMTs), who provide immediate medical assistance and transport patients to emergency facilities.

Q: What is the purpose of EMS billing?

A: EMS billing is necessary to charge for services provided during emergency medical transportation, including assistance, non-transport calls, and transport to hospitals.

Q: How is EMS typically billed?

A: EMS services are billed to insurance payers like Medicare or Medicaid when a patient uses ambulance transport to a hospital. Insurance premiums usually cover EMS costs, and patients may need to pay a co-pay or deductible.

Q: What happens if insurance does not cover the full EMS bill?

A: Residents may not have to pay the difference if insurance does not fully cover the bill. However, non-residents are responsible for co-pays, deductibles, and any uncovered amounts.

Q: How is the EMS billing process initiated?

A: The billing process begins with the patient (or their representative) signing a form that allows the hospital to bill the insurance provider for services. If the patient cannot sign, ambulance crew members may sign on their behalf.

Q: Are there any exceptions to the EMS billing?

A: If a fire truck accompanies an ambulance but does not transport a patient, no charge is applied for that service. Additionally, a bill may be written off for uninsured residents after verification.

Q: How are the funds from EMS billing used?

A: Funds collected from EMS transport billing are utilized to support the EMS operations and the fire-rescue department, ensuring continued community health and safety.

Q: Who can I contact for questions about EMS billing?

A: For any inquiries regarding EMS billing, you can contact Medical Billers and Coders for expert assistance and a free financial health check-up to identify missing revenue.

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