EMS was hit with unsavory press recently – big article in the Washington Post and Kaiser Health News about the detrimental impact on patients of large bills generated by ambulance trips and articles that discuss the use Lyft or Uber over ambulance. While the American Ambulance Association gave an informative and eloquent response, it is still distressing to our industry when the world does not understand what we do. For those who work in EMS, the pushback from patients and the community is difficult to bear.


I believe the publication of these articles provides us an opportunity to increase awareness about the challenges we face. In addition, this is a chance for us to re-evaluate how we operate. Let’s talk about what you can do about two of the biggest issues discussed in the article:

·         Patient balance billing; and,

·         Out-of-network transports

Patient Balance Billing

If the transport was an emergency, first assure the billing department investigates every possible route to third-party payment. When a patient has insurance, emergency service is usually covered. The claim may not be paid in full, but generally there is coverage for emergencies (non-emergency services are not so lucky). If the payer makes a partial-payment only, attempt to go back to the payer – explain this was a 911 call. It is far easier and timely if the provider pursues the payer than waiting on the patient. If all third-party payment options are exhausted, then bill the patient.

BUT, help the patient (and the community) understand why you are billing. The public truly does not understand what is involved in the provision of EMS services. We need to educate them – which is something that all providers can do.

A couple years ago, a joint task force on medical debt published recommendations on fairness and consistency in medical account resolution.  The task force strongly supported patient education and discussion about shared responsibility.

Ok, no emergency provider can stop their patient care to “educate” about billing. But, your website can. Emergency patients will not visit your website prior to calling 911, but they are likely to visit later. Use your website to inform visitors about what’s involved in providing your service – your 24/7 availability and the costs to be there. Let people know what your billing policies are. Offer various options for payment – credit cards, PayPal and time payments. Establish a good financial hardship policy and outline how to access it. Assure patients you will work with them on financial matters…and for emergency providers, that you will be there no matter their ability to pay.

Have you assessed how well you communicate with patients about their bills? Take a good look at the statements you send patients. Is the document clear, concise and correct? If your 82-year-old father looked at your ambulance statement, would he be able to understand it? Is the contact number easily seen? If your bill has gotten messy or complicated, contact your software vendor for help to streamline the process.

Out of Network Transports

If you perform non-emergency transports, an out-of-network trip should be unusual, not the norm. This means out-of-network patient bills should be rare. Look at your call center. Have a good workflow for incoming calls. If emergency calls come directly to you, assure you have dispatch protocols that follow Medicare’s guidelines. An emergency does not need to be in-network for reimbursement to occur.

For transports that are non-emergency in nature, it is critical that your call center assure you are the appropriate provider to render the service. Reimbursement for non-emergency transport is tied to one of three things:

·         The provider has a contract to provide the non-emergency service

·         A prior authorization was issued by the payer

·         The provider is in-network with the payer

Protection for payment of non-emergency services is practically non-existent unless there is contract or payer network participation. This means your call-takers need to ask who the payer is prior to dispatching the ambulance. If the neighboring ambulance service is contracted with the payer and you are not, it is not in your best interest to transport the non-emergency patient. Depending on some regulations, you may even be prohibited from billing the patient which leaves you stuck with uncompensated trips.


This is another time when your website can be helpful to your patients. Note the list of payers with whom you contract. If appropriate in your state, provide links to Medical Assistance insurers or transport brokers for patients to initiate transport requests. Publish your billing policies with various options for payment.


You will not solve every balance bill problem. However, you can assess your process and the information you share with the public to make improvements.


Let us know if we can help!


About the author:  Maggie Adams is the president of EMS Financial Services, with 25 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. “Like” EMS Financial on Facebook, follow us on LinkedIn or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com