Is Now the Time to Re-engineer the EMS Billing Process?
Achieving exceptional emergency medical services (EMS) revenue cycle performance requires effective cost control, increased productivity, and optimal reimbursement. Yet progressing a claim through its lifecycle has traditionally been a labor intensive and inefficient experience. Revenue cycle experts have proposed and implemented new solutions for decades. However, EMS agencies still struggle with missing information, disconnected workflows, and complicated billing processes.
Could this be the decade we finally eliminate redundant, repetitive work in the EMS billing process in favor of spending less time chasing facts and more time getting results? Will patients finally receive accurate and understandable statements versus confusing or erroneous bills?
In an era where patient satisfaction rules supreme, now is the time to re-engineer the EMS billing process to deliver more performance and efficiency for agencies and a more satisfactory experience for patients. This blog explores three practical ways technology augments the billing process and experience for everyone involved.
Information Gaps Plague EMS Billing
One of the most critical billing challenges faced by EMS agencies is the ability to obtain and verify patient demographics and insurance coverage during or after a medical emergency. EMS crews often rely on the destination hospital to verify or provide patient information later, after the patient is admitted. Here are three common EMS billing scenarios.
- Information is exchanged between hospital and EMS agencies, often by phone or fax, resulting in delays. Data re-entry is required, which exacerbates risk of error.
- Hospitals pass information gaps on to EMS agencies. They capture erroneous patient demographics or fail to record the proper insurance coverage, such as Medicare beneficiary identifiers, private insurance group numbers, and federal poverty level or charity care eligibility.
- Patients receive incorrect EMS bills, or the statements are sent to the wrong address entirely. Even if the patient’s emergent care and ambulance transport were excellent, receiving an incorrect bill taints their entire healthcare experience.
Without immediate access to complete and accurate patient information, the EMS revenue cycle is delayed — preventing timely reimbursement and ultimately degrading the overall billing experience. The importance of leveraging technology to fill information gaps, accelerate workflow, and augment billing processes becomes even more urgent for unemployed and underemployed patients. Insurance coverage for these patients may have been reduced or lost entirely in the wake of COVID-19, leaving them with limited financial resources to cover EMS costs.
COVID-19 Has Increased Self-pay and High Deductibles
A recent analysis by the Economic Policy Institute (EPI)* reports that 6.2 million U.S. workers have lost access to health insurance through their employer amid job losses during the pandemic. When considering spouses and dependents in those plans, the number of people losing employer coverage is closer to 12 million. Of those, about 5% are eligible for Medicaid, while others are forced to make the hard choice between self-pay and high-deductible health plans (HDHP). According to the EPI, public insurance (mostly Medicaid) has not expanded enough to absorb everyone who lost employer-based coverage. Medicaid rolls have likely expanded by more than four million since the COVID-19 outbreak.
EMS agencies are increasingly vulnerable to the impact of higher deductibles on dwindling revenue. If a patient has a very high deductible, the agency will not likely get paid by insurance. The good news is, technology can also help with the world of high deductibles. As one example, where payers provide deductible information, ZOLL® Billing can determine whether or not the patient’s deductible has been met. If not, agencies can hold a claim until the hospital has collected the patient deductible. Once that has been met, the payer is responsible for the patient’s ambulance bill. Here are three other ways technology supports re-engineering the billing process and experience.
Three Ways Technology Improves the Billing Process
The recent wave of advanced, intelligent technologies establish new gold standards for EMS claims processing, billing workflows, and payment posting. Each function should be thoroughly assessed by EMS agencies in light of existing capabilities and integration options. Here are best practices to consider during the evaluation.
During an emergency, 911 call-takers or medics are not expected to prioritize the collection of demographic and insurance information. This means billers must rely on dispatch software, patient care software, or the hospital to find insurance information when an agency’s EMS software is not fully integrated. Searching numerous payer portals can be extremely time consuming and labor-intensive.
New EMS integration capabilities bring patient demographic, insurance coverage, and consumer credit reporting databases into the billing system. EMS billers have easy access to all the information and attachments required to process the claim more effectively and efficiently. Agencies can receive optimum reimbursement in less time, while reducing the time staff spends on pre-billing tasks.
Workflows are affected by factors such as the accuracy of information on the claim and how the claim was created, routed, and posted. Perhaps a signature is missing or the claim has gone to a payer that has not responded with explanation of benefits or payment.
Embedded workflows ensure claims will progress through their lifecycle and get flagged depending on different scenarios. For example, if a biller creates a claim that indicates the patient has not signed for release of information and assignment of benefits, the system flags that claim as “suspended — signature needed for billing.”
Finally, systems should track posted payments in real time and automatically flag the status to indicate underpayment, overpayment, or correct payment. Claims that require attention can then be quickly routed via embedded workflows to the right person at the right time to ensure accurate, efficient processing.
Strategies to Control Costs, Increase Productivity, and Accelerate Reimbursement
In September 2019, the Healthcare Financial Management Association (HFMA) surveyed hospital and health system CFOs and revenue cycle management (RCM) executives to learn more about revenue cycle challenges and strategies to address them. Among the top concerns were patient payment responsibility, HDHPs, and the need for technology beyond electronic health record (EHR) capabilities.
According to the report, healthcare organizations, including EMS agencies, are looking outside their organizations to collaborate with external entities and leverage advanced technology solutions to improve revenue cycle performance. However, engaging multiple vendors often has the opposite effect. It drives up management’s time spent on coordinating entities, increases interface costs to connect systems, and adds complexity to biller workflows.
Therefore, the onus is on technology vendors to build integration into their solutions and build collaborative partnerships with their customers if the goal is truly to re-engineer the billing process. ZOLL Data Systems takes this responsibility very seriously. Our tools for demographics, insurance discovery and verification, and more are integrated into the ZOLL Billing solution for EMS, as well as into our ZOLL AR Boost solution for other healthcare providers. In addition, we partner with a dedicated clearinghouse to process claims for accuracy before they are sent to payers. Agency billers can send statements directly to patients via our billing solutions, thanks to integration with the agency’s technology stack for the capture, transfer, and use of data. These features reflect our commitment to improving the healthcare journey by delivering best practices, technological innovations, and truly integrated partnerships to our clients and our industry.