Solving the Unique Revenue Cycle Challenges of EMS Providers

Common front-end hurdles wreak havoc on back-end EMS staff efficiency.

Emergency medical service (EMS) providers face unique, inherent challenges in capturing correct patient demographics and verifying insurance coverage. During ambulance transports, attention is focused solely on patients’ emergency medical conditions—as it should be. And once transports are complete, EMS staff can’t easily visit patients’ rooms to obtain financial details, as is best practice in acute care hospitals and health systems.

This common front-end hurdle wreaks havoc on back-end EMS staff efficiency. At one large ambulance provider organization, the Regional Emergency Management System Authority (REMSA), in Reno, Nevada, the inability to find insurance for EMS patients drained staff productivity and burgeoned the number of accounts sent to collections. This was especially true for REMSA’s rising volume of self-pay accounts.

EMS providers are equally handicapped in the technology arena. Technology integration and electronic health record (EHR) access are woefully lacking for most ambulance companies. And the absence of capital resources and IT knowledge to implement revenue cycle tools is a common scenario for EMS providers.

Well-recognized practices to boost revenue cycle efficiency in acute care organizations don’t always address unique EMS challenges. Innovative thinking and overlapping technologies are required to pave a successful path to stronger collection and revenue recognition. Such was the case at REMSA.

Evaluate and Automate

With 45,000 trips annually and a growth rate of 5-6 percent year over year, the first step was to begin automating processes within REMSA’s business office and revenue cycle teams. Three key goals were identified:

• Capture accurate patient demographics sooner in the revenue cycle.
• Discover more billable insurance coverage to increase revenue and reduce collection costs.
• Eliminate local printing of patient statements and invoices.

Technology and service companies with EMS experience were interviewed to address these revenue cycle gaps. REMSA employees were directly involved in reviewing software purchases and creating new ideas on how to improve workflow and processes.

Revenue cycle efficiencies can’t be realized unless core competencies are intact. As a result, REMSA conducted a careful audit and evaluation of core revenue cycle functions to answer the following questions:

• Are in-house coders and billers competent?
• Do the staff have access to appropriate systems to retrieve information?
• Are all employees properly trained on correct patient account and collection follow-up protocols?
• Is someone assigned to understand the legalities of denials and appeals management?

With processes improved and the right staff in place, technology implementations began. The organization’s strategy focused on automating the three revenue cycle management functions mentioned above related to up-front and accurate capture of patient demographics and insurance coverage and eliminating patient statement printing.

18 Percent Case Reduction, 50 Percent Drop in A/R

Technology to search and discover commercial coverage for more patients was a primary goal to reduce cases sent to collection and accounts receivable (A/R) days outstanding. The team completed a comprehensive upgrade to its EHR system and engaged two new revenue cycle technology partners.

After 24 months, REMSA has effectively found more billable commercial coverage for its patients, reduced collection costs, and increased cash flow. There has been an 18 percent reduction in the number of cases sent to REMSA’s third-party collection agency through stronger revenue cycle automation.

Clean claims, coding, and data integrity also improved, leading to a 50 percent reduction in A/R days. The impressive drop in A/R is attributed to a combination of better internal processes, streamlined workflows, and the implementation of revenue cycle automation software.

EMS Revenue Cycle Takeaways

Paving a path to EMS revenue cycle efficiency starts with an understanding and acceptance of the unique nuances in pre-acute care. While improving cash flow and reducing administrative burden are universal goals in health care, ambulance providers are notably behind other organizations. Conducting an internal audit of EMS staff and workflow before implementing revenue cycle technology is imperative.