Recently I conducted a documentation training session. Included in the class were members of the company’s billing department. They were eager to see the crews get their “come-uppance” with training in the areas that billing felt crews were lacking. At break-time, one of the billers approached asking that I put much more emphasis on the narrative. She felt the narrative was the most important part of the trip report because that’s where she obtained all her information to bill the claim. She was surprised when I did not totally support her position.

Yes, the narrative is very important, but, there is much more to the report than just the narrative. The report needs documentation of patient demographic information, ambulance dispatch priority, vital signs, first impression, documentation of an ALS assessment (if performed), past medical history, current medications, history of the present incident, how the patient was found and moved, and what treatments or interventions were provided.  To document all the required information takes time. Fortunately, we have mighty fine electronic patient care report (ePCR) systems – Zoll, ESO, emsCharts, Image Trend, AIM/RAM, etc. The systems are mobile, able to be uploaded, and, most importantly, designed to make charting better and less time consuming for field crews. Trip reports are a clinical record, a quality assurance mechanism, a way to track statistics and resource use, as well as the tool we need to obtain reimbursement.

Important point here – it really is the crews’ first job to care for patients. A trip report that takes more time to complete than the amount of time spent on the call could impact the ability to care for other patients. Of course, without reimbursement they won’t be able to continue to do that primary job which is why a good trip report is essential. But a trip report should not overly time-consulting. Crews do need training – and frequent reminders – about the serious elements required in a PCR. Billers need the information – and the appropriate signatures – to make a good billing decision.

That’s the job of billing – they analyze the information in the patient care report and make a billing decision. Does the trip qualify for billing? What payer gets the bill (Medicare, Medicaid, commercial insurance, the facility or the patient)? What level of service is appropriate for the claim? The information a biller needs resides throughout the trip report. The narrative is not the only thing.

A narrative is the place to bring all the threads together. The narrative is the place to tell the rest of the story about the patient, their needs and the crews’ interaction with them. We recommend that crews receive training on the importance of a good trip report. Tell crews how to use their software well and to document all the essential elements of the report. Work with them to avoid the tendency of some crews to click on the first item in the drop-down box of the trip report (which might be the easiest option but is not always the best option). Teach the importance of narrative’s use in “painting the picture” of the patient’s need for ambulance and trained personnel.

Billers need education on how to look at the entire trip report. They also need to understand how to read the narrative to assure that it does bring all the pieces of the puzzle together. With that knowledge, billers will be able to make the best decision on how to bill.

It’s all about revenue integrity – revenue is getting to the reimbursement; maintaining integrity is how you get to keep that reimbursement.

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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 or visit