Welcome to 2017 and get ready for the whirlwind! The players have been chosen. We now know more about what to expect from the next era of healthcare. We can start to prepare for the impact on EMS management and revenue. Keep reading for concrete steps you can take now to assure you are ready for challenges ahead.

Both Tom Price (designated head of HHS) and Seema Verma (nominee for CMS administrator) have a history of supporting personal responsibility in healthcare coverage. In the case of Ms. Verma, she helped design a Medicaid program for Indiana that expects Medicaid recipients to bear financial responsibility for their care.  As noted in the Indiana Health Coverages Programs Provider Reference Manual for Transportation Services, it is required that co-payments are collected at the time medical transportation services are rendered (with the exception of emergencies). There is also a requirement in Indiana to pursue delinquent payments from Medicaid patients in the same way delinquent accounts are pursued from private-pay patents. Clearly, Indiana expects a degree of financial responsibility from Medicaid patients. There is also talk about making changes to Medicare.

The process of changing the Affordable Care Act will be just that – a process. But there is some handwriting on the wall that is screaming at EMS providers to prepare. Here are my suggestions on steps you can take today:

·         Emergency providers – we don’t know yet if anyone will lose insurance coverage from the upcoming changes. But a coverage loss could lead to more emergency calls. Why? Because EMS history has shown that patients without insurance coverage tend to wait to seek care. Delayed care may lead to an exacerbation of the patient’s condition and a subsequent emergency. Any change in coverage is likely to happen to Medicaid recipients and members of Medicaid managed care. Therefore, it is a good idea to look at your payer mix to see what portion of your patients are Medicaid.


·         Emergency providers – consider contracting with payers. I have not always been an advocate of emergency provider contracts; however, the world is changing and so has my view. Emergency services are covered services. Contracting with payers will give emergency providers numbers they can rely upon. Emergency providers will be better able to plan their cash flow and expectations. Yes, I know the rate of reimbursement is not always optimal. But there may be protections under state law (like New York) that shield providers in case of “adverse reimbursement changes” or provisions that address timely filing that can be helpful. Remember, I said “consider contracting.” Now may be the time to visit/revisit this topic to ascertain if contracting would be in the best interest of your cash flow needs.


·         Non-emergency providers - be prepared if you need to collect or bill Medicaid recipients. Check your signature forms. Does your state require any specific language for Medicaid recipients? If you need help in this area, contact your state ambulance association. The state association will be up to date on the latest requirements for patient financial responsibility.


·         Medicaid co-pay requirements could be instituted, especially for non-emergency services. Start thinking of ways to equip your wheelchair van drivers and non-emergency ambulances with a mechanism to address payment collection. See the next bullet point. The mechanisms could be something as simple as smart-phone applications that accept payment or a lockbox maintained on board for cash.


·         Do non-emergency crews or wheelchair van drivers have knowledge, training and awareness to collect needed co-pays at the time of service? Now is the time to plan for staff education.


·         Billing for small amounts if less successful, but it billing is your choice, assure that the billing staff is properly trained to pursue small balances with the same vigor as larger balances.


·         Non-emergency call intake more critical than ever for ground AND air providers

o   Pre-verification of insurance coverage, limitations, authorization and co-payment requirements will be essential information that must be obtained prior to rendering service

o   Call intake personnel are uniquely qualified to assist in this effort


·         Stay informed and stay involved. Your elected officials need to hear from you routinely about the issues you face as healthcare continues to evolve.

Let us know if we can help!

About the author:  Maggie Adams is the president of EMS Financial Services, with over 20 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. Check out our newest documentation training webinars and billing webinars on our website.Friend EMS Financial on Facebook, or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com