(3 min read) The lay of the land in EMS billing used to be “Zero Day Billing.” This meant that emergency medical service (EMS) agencies would work tirelessly to streamline their documentation and revenue cycle processes to get claims out the door as fast as humanly possible to promote cash flow.
While prompt billing still makes sense for some payers, like Medicare and Medicaid, the days of Zero Day Billing for commercial health insurance plans are long gone. Today’s high-deductible health plans mean higher patient out-of-pocket costs and a much longer wait each year until the patient’s annual deductible is satisfied and benefits start kicking in. So, if an EMS agency bills too promptly, they will find that their claims will not be paid, but that will fall into the ever-expanding black hole of "patient deductible."
The goal in today’s changing commercial health insurance landscape is “Right Day Billing.” This means that speed doesn’t always win the race in your billing process.
“Payer mix” is a term that describes the categories of payers and the portion of your agency’s revenue that comes from each. The four primary categories are: Medicare, Medicaid, Commercial Insurance, and Self-pay. The EMS payer category that has the lowest rate of return by far is Self-Pay. Anecdotally, many EMS agencies report that self-pay collection rates are consistently less than 10% of amounts billed; in fact, most agencies would be likely to report a rate in the range of 4-7%.
This means that any time an unpaid balance falls into the self-pay category, your agency is likely to receive only pennies on the dollars it is owed. Therefore, anything you can do to keep the balance from falling into the self-pay bucket – and instead, falling into one of the “insured” buckets – greatly increases your chances of capturing a meaningful return on the account.
Your agency must become adept at monitoring the patient’s deductible and timing claims so that other providers take the deductible hit, making it much more likely that your claim will be paid by the patient’s insurance. While the critical task of deductible monitoring can be done manually by checking with the individual payer or by utilizing clearinghouses to assist in this task, truly efficient agencies will utilize an integrated solution that can automate, centralize, and simplify the task of monitoring deductible status to maximize agency revenue.
When the consultants and attorneys at PWW perform on-site billing process evaluations of our clients, one thing we focus on is workflow and efficiency in the revenue cycle functions. The use of technology to achieve success in the EMS billing process is a key component of good revenue cycle management. Our clients have found that their investments in automated deductible management tools – such as the one in the ZOLL® AR Boost® solution – have paid off quickly and covered the initial expenditure many times over.
Deductible management is a key to EMS agency revenue cycle success, and leveraging technology effectively is, undoubtedly, a key to effective deductible management. Goodbye, Zero Day Billing – hello, Right Day Billing.