In our experience providing services and software to agencies across the country, the EMS experts at AIM hear common questions about EMS billing services. If you’re considering outsourcing your EMS billing, these frequently asked questions (FAQs) can prove valuable in the decision process.
Q: How do we know if outsourced EMS billing is right for us?
The decision to outsource EMS billing usually comes after an agency has struggled with pain points that make it difficult to operate efficiently and profitably. Many find it tough to attract and retain qualified employees to staff the billing function. They might not have the necessary equipment and software specific to EMS operations, or they might prefer not to make those investments.
While every agency’s situation is unique, many discover they can have significant benefits by outsourcing billing, such as gaining more time for patients, optimizing revenue, increasing billing accuracy, speeding reimbursement, smoothing cash flow, and getting better access to financial performance data.
Q: What kind of return on investment (ROI) can we achieve by outsourcing our billing?
Agencies often find they can achieve a strong ROI by outsourcing their billing when factoring in the costs associated with handling this function in-house—including labor, IT, printing, and clearinghouse expenses. A billing services provider can walk you through that calculation and help you determine the ROI on moving your billing to a third party.
Q: Besides the most basic services, what should we expect an EMS billing vendor to provide?
Any EMS billing service will handle the basics, like creating bills from PCR data and submitting them through a payer website, clearinghouse, or patient invoice. But for the best experience and the greatest ROI, the vendor should provide other services that add significant value.
For instance, the billing vendor should:
- Assist with training your crews on how to complete accurate, comprehensive PCR narratives that provide the documentation needed to validate the transport as billable
- Provide easy access to useful reports, such as run reports, A/R numbers, claim status, team productivity reports, and trend analysis
- Make it easy for you to respond to routine payer audits, by organizing all the billing documentation during the normal course of their work
- Submit claims electronically and optimize electronic payments wherever possible to speed reimbursement
- Help clear up any backlog that can result when you switch from one billing provider to another or from in-house to outsourced billing
Q: What qualities should we look for in an EMS billing services provider?
Since billing is mission-critical, it’s vital to choose a vendor that can handle this function flawlessly. Look for a provider with a long history of experience in EMS billing specifically and certified ambulance billers on staff. It’s also helpful if the billing team includes previous EMTs and dispatchers who understand the clinical side of the business.
Find out how many EMS agencies the vendor provides billing services for, whether any are similar to yours in size and scope, and how many are long-standing relationships. The vendor should also provide testimonials from satisfied clients and put you in touch with EMS agencies that will offer a reference.
Finally, ask about the vendor’s commitment to service. Often, EMS agencies switch billing providers because they’re dissatisfied with the service they’re getting from their current vendor. You’ll want to partner with a vendor that provides responsive, accurate service and is readily accessible to your team, through channels such as phone, email, and live chat.
Q: Is there a meaningful difference between general medical billing services and EMS billing services?
Absolutely! EMS billing is much more specialized than general medical billing, for a variety of reasons. For example, unique regulations govern EMS billing, largely driven by Medicare. And since EMS crews don’t diagnose patients, billers need to determine the best diagnosis for the transport to ensure proper reimbursement. Billers that are accustomed to general medical billing won’t have the knowledge or expertise to navigate the nuances of EMS billing.
Q: How do EMS billing providers ensure and demonstrate quality?
Any EMS billing services provider should adhere to rigorous, well-documented quality standards and processes to ensure accuracy. They also should provide full transparency into billing data—not just the invoices, but important metrics like biller productivity, number of daily postings, number of bills submitted daily, number of denials, and other measures that illustrate their service quality.
Q: How will an EMS billing provider ensure data security and privacy and help us maintain compliance?
Reputable EMS billing providers will ensure compliance with HIPAA and other relevant federal or state regulations and apply rigorous measures to secure your patient and billing data. Ask the vendor which EMS billing software they use and whether it has built-in features that keep the billing process compliant. Find out if the vendor is SOC-certified, which means they adhere to industry-standard practices for data security and privacy.
Q: If we outsource our EMS billing, will we have the flexibility to bring it in-house later?
If you choose a billing provider that also offers a billing software package, you’ll have the greatest flexibility to bring this function in-house later. Sometimes an agency wants to outsource temporarily, with the longer-term goal of handling billing internally. AIM billers use the same EMS Billing Software we sell to EMS agencies, so all the required data already resides in the same system the agency would use for in-house billing. That makes any transition seamless and easy.
Q: Will an outsourced provider set up a dedicated billing team for our agency?
Some EMS billing vendors allocate different billers to separate tasks, payers, or portions of the workflow. In our experience, this approach makes it difficult for the agency to get answers to questions or fulfill simple requests like accessing specific report needs. For the most responsive support, AIM assigns a dedicated team that handles the agency’s billing workflow from start to finish, with a lead biller and RCM manager serving as the key contact points.
Q: What does a typical outsourced billing workflow involve?
As a best practice, an outsourced EMS billing services provider should follow a workflow that includes:
- Detailed training and education that equips your crews to support a streamlined billing process
- Bill verification, including reviewing the PCR and supporting documentation and verifying insurance
- Claim submission, including coding the bill, attaching supporting documentation, and submitting electronically wherever possible
- Bill management, including monitoring status, posting payments, printing patient statements, and working denials or appeals
- Bill closing, including attaching paper EOBs and payment stubs to the billing module and providing status updates and reports
Q: Will an outsourced billing service integrate with our ePCR software?
Since the billing process demands accurate, complete PCR data, integration between the ePCR software and the billing service is critical. At AIM, we enable our billing services clients to use our fully-integrated ePCR Software module at no additional cost (as well as our Dispatch Software at a nominal cost). This approach reduces operating expenses and improves ROI. If the agency prefers to use a third-party ePCR solution, we’ll integrate with that package to ensure a smooth billing process.
Q: How do EMS billing providers handle claim denials and appeals?
Your billing services provider should reduce claim denials by ensuring complete, accurate submissions. But if a claim is denied, the vendor should follow a diligent process for responding and potentially appealing. That includes knowing each payer’s specific denial and appeal requirements and establishing policies for prioritizing denials (so they don’t fall through the cracks as billers focus on new claims).
Q: What other questions should we ask an EMS billing services provider?
Many agencies that are experiencing poor billing performance have discovered the vendor is using overseas resources to supplement the domestic team, especially in a tight US labor market. When billing service quality and responsiveness drops, it often correlates with the use of non-local resources. It’s prudent to ask if the EMS billing vendor outsources work internationally or if all the work is done by US staff.
Choose AIM for EMS Billing Services
With 1.5 million billable transports, $1.2 million billable charges, and $409 million payments processed, AIM is the partner of choice for EMS agencies that want to experience all the benefits of outsourced EMS billing. We’re experts at speeding reimbursement and optimizing revenue for EMS agencies. And our customers give us an NPS score of 83—higher than world-class companies like Apple and Amazon.