Create a collaborative team to regularly discuss patient care documentation, EMS billing, collection, denial, and appeal metrics as part of continuous improvement. EMS agencies continue to struggle to make ends meet. The cost of EMS patient care continues to rise, while ambulance reimbursement rates continue to disappoint. In addition, Federal and state regulations continue to multiply. When payers and regulators fail to see the immense value EMS brings to healthcare, economical solutions can be hard to find.