EMS Billing: How Much?

[firedude 985]

What do most EMS agencies charge for transport (ALS & BLS)? Do they also charge per mile driven? If so, how much? Who is in charge of the rate being charged? The reason why I am asking is because a local agency is trying to boost the price.

Thanks in advance.

[PFDRes47cue 653]

$0.00.

[FireMedic049 597]

What do most EMS agencies charge for transport (ALS & BLS)? Do they also charge per mile driven? If so, how much? Who is in charge of the rate being charged? The reason why I am asking is because a local agency is trying to boost the price.

Thanks in advance.

I am by no means an expert in EMS billing, but it is my understanding that the EMS agency itself sets its own rates. This is typically done via whatever governing body the agency operates under (i.e. Board of Directors, Ambulance Authority, etc.) Typically there is also a charge per loaded mile (when a pt is onboard). Now there may be some places where this is not the case.

Most insurance carriers along with Medicare/Medicaid have their own reimbursement rates for ambulance services. These rates are what they will actually pay for whatever service has been rendered.

So an ambulance service could charge $1,000 for a BLS ambulance transport. If the insurance only pays $500 for a BLS transport, then the ambulance service can either accept that as payment or bill the patient for the balance. All ambulance services that I'm familiar with that do "subscription drives" will waive that balance for those who purchase those "subscriptions".

[ny10570 745]

In most cases the EMS agency cannot pursue the patient for additional money. There are a few important distinctions here.

First, is this only applies to emergency treatment and ground transport. Any 911 call qualifies, I'm not sure how it works for emergent commercial transports, so we'll stick to 911.

Are we talking about patients with comprehensive healthcare coverage or catastophic or other types of coverage? Only with comprehensive coverage are patients required to be provided with ambulance coverage. Few catastrophic plans do and certain limited coverage plans do. As long as your plan covers emergency prehospital ground transport this applies.

Next, does the agency have a participating provider agreement with the insurer? If they do, then whatever billing rates are agreed upon apply to all transactions. For example, the insurer could agree to pay the first $500 and the patient would be on the hook for any additional billing. Without a participating provider agreement in place the patient is responsible for any co-payments or deductibles and nothing more. The insurer is responsible for paying a "customary reasonable allowance". This customary and allowable allowance is often higher than, but close to the medicare rate. Any attempt to further collect that debt would be illegal under NY Insurance law article 32. Depending on how aggressive they are in collecting their money, violations of General Business statutes and Executive orders may apply.

Currently FDNY is proposing a new fee schedule to start some time this month. An increase from $515 to $704 for BLS, $750 to $1190 for ALS1, and $850 to $1290 for ALS2.Mileage and oxygen will be going up as well, $50 to $60 for oxygen and from $7 to $12 for each mile. I think medicare is currently paying around $250 for BLS, but even that doesn't matter for FDNY since we receive a percentage of HHC's annual payout from Medicare and Medicaid and no individual disbursements from those funds.

Edited February 3, 2012 by ny10570

[nfd2004 750]

There are ambulance services that also charge for "NOT TRANSPORTING". If someone refuses to be transported, they sign the wavier requesting no transport (they didn't call for the ambulance). And a few weeks down the road, a bill shows up for Not Transporting.

[helicopper 1,050]

Doesn't Medicare or some other outside entity set the rates for reimbursement by most of the insurance industry?

You can bill any amount you want but you're not going to get it all back. You'll only get a percentage.

[helicopper 1,050]

$0.00.

Is that a good thing?

What's wrong with having users of the service subsidize the system? It reduces the cost to all the taxpayers who don't use it.

[fire2141 33]

I am by no means an expert in EMS billing, but it is my understanding that the EMS agency itself sets its own rates. This is typically done via whatever governing body the agency operates under (i.e. Board of Directors, Ambulance Authority, etc.) Typically there is also a charge per loaded mile (when a pt is onboard). Now there may be some places where this is not the case.

Most insurance carriers along with Medicare/Medicaid have their own reimbursement rates for ambulance services. These rates are what they will actually pay for whatever service has been rendered.

So an ambulance service could charge $1,000 for a BLS ambulance transport. If the insurance only pays $500 for a BLS transport, then the ambulance service can either accept that as payment or bill the patient for the balance. All ambulance services that I'm familiar with that do "subscription drives" will waive that balance for those who purchase those "subscriptions".

The provider must accept fee given by insurance company with no additional fees as per NY State law. I know I've been through this.

[Alpinerunner 61]

There are ambulance services that also charge for "NOT TRANSPORTING". If someone refuses to be transported, they sign the wavier requesting no transport (they didn't call for the ambulance). And a few weeks down the road, a bill shows up for Not Transporting.

This makes sense cases where the patient called 911, got an evaluation, then refused transport. It seems there is always a push by ambulance services to transport since that is the only way they get paid. They should get paid if they provide evaluation or treatment on scene, since that is where their skills and equipment are used. They aren't trained as a taxi service so that shouldn't be the stipulation for billing. It should reduce the strain on hospitals by cutting down on unnecessary patients, too.

[JJB531 652]

Is that a good thing?

What's wrong with having users of the service subsidize the system? It reduces the cost to all the taxpayers who don't use it.

I agree. I don't mean any disrespect, but I can't understand the "pride" that goes along with not billing. You're not billing the individual, you're billing the insurance company. We're not kicking down patient's doors to collect payment, we're not the EMS "mob". As EMS agencies, we are a part of the healthcare system, and should utilize the same compensatory measures that any other part of the healthcare system does. Collecting payment, as little or as much as it might be, offsets the overall cost needed to run the agency from the people who are actually using our services (in other words our patients). Put that collected money to good use (i.e. training, equipment, uniforms, etc.) and not on unnecessary items (i.e. parties) and it's only going to help advance the individual agency and enable you to continue to not just provide the service you currently do, but also expand your capabilities.

[ny10570 745]

There are ambulance services that also charge for "NOT TRANSPORTING". If someone refuses to be transported, they sign the wavier requesting no transport (they didn't call for the ambulance). And a few weeks down the road, a bill shows up for Not Transporting.

Who does that? I know NY and medicare only reimburse for transport. Since insurance companies generally follow the medicare guidelines I'd imagine they would refuse to pay those as well.

[antiquefirelt 994]

If your service bills Medicare, then you must follow their rules or risk an audit which freezes any MC payments until you prove you're in compliance. Medicare rules include fee schedules that differ region to region and even within regions as they see fit. What we bill in Maine differs from what you can bill MC in NY due to the regional fee structures.

As far as I know, unless the rules have changed recently, billing for no transports is a violation of MC rules, so if you're billing MC and they get a bill for a no transport, you make get audited. Part of the audit is that they supposedly can and will force you to refund any payments made by MC for such time that you've been operating outside their guidelines.

I suspect if you bill the patient directly and do not send bills to insurers than the MC rules probably don't apply. TI can tell you their rules are complex and numerous and some billing companies understanding of their rules vary greatly.

BTW, when you bill Medicare, they make you follow their rules, for all billing, not just to them, you must have one set of billing practices for all patients.

Edited February 3, 2012 by antiquefirelt

[nfd2004 750]

Who does that? I know NY and medicare only reimburse for transport. Since insurance companies generally follow the medicare guidelines I'd imagine they would refuse to pay those as well.

Here in Connecticut there are private ambulance companies that DO Charge for a non transport. And it doesn't matter who calls. It could be a MVA and I ride by and call 911. I tell them, "I think there's injuries". The ambulance shows up, the parties refuse transport and say they are Not injuried. Then the EMS team ask the victim to sign the release form and that victim is later charged for a Non Transport call. Of course not the full rate, but about half the normal transport fee.

[sympathomedic 383]

I did a bit of research into this area of mystery a year back. Here is what I can tell you: about 80% of billables are medicare calls. The rest are car insurance companies, medicaid, workmans comp and private insurance.

Medicare pays 80% of what they think a call is worth, regardless of what you think it is worth. They have prices for ALS level 1 calls, ALS level 2 and BLS. Mileage is the same for all and it is like $9 per mile traveled WITH the pt on board only. I do not have the exact $$ figures in front of me, but the ALS level 2's are like $1200. Very rare- pt must have 3 meds given and Nitro, ASA and combivent/albuteral don't count. Anything less is ALS 1 and is about $480. BLS is about $270. BUT remember, that what they think it is worth: They pay 80% of that.

Car insurance companies used to pay whatever you charge, but they are now in court with some larger providers, suing to pay only what medicare pays.

By law, you can not charge the medicare MORE than what you charge anyone else, so medicare pays equal or higher than other payers. I beleive medicaid pays 20%, but I am not sure if that is 20% of YOUR bill, or 20% of their idea of a bill.

Private insurance that I have had pays in the $100 to $300 range. Not sure who gets to pay the rest, if anyone.

If anyone has other info, there is a good chance it is better than mine. Bill

[sympathomedic 383]

Correction: Medicare pays equal or LESS than other payors.

[FireMedic049 597]

The provider must accept fee given by insurance company with no additional fees as per NY State law. I know I've been through this.

I'm assuming you are referring to the unpaid balance as an "additional fee". That may be the case in NY, but is not the case in PA to the best of my knowledge.

[FireMedic049 597]

Here in Connecticut there are private ambulance companies that DO Charge for a non transport. And it doesn't matter who calls. It could be a MVA and I ride by and call 911. I tell them, "I think there's injuries". The ambulance shows up, the parties refuse transport and say they are Not injuried. Then the EMS team ask the victim to sign the release form and that victim is later charged for a Non Transport call. Of course not the full rate, but about half the normal transport fee.

The agencies that I've worked for that have done non-transport billing have only charged a nominal fee - something like $50-$100. Not sure if they billed all non-transports or just the ones in which we provided actual assessment and/or treatments. Not sure if they billed more for ALS treat and releases, like a diabetic given D50 who then refuses transport.

[antiquefirelt 994]

Our agency only charges mutual aid towns for non-transporting calls. By agreement we provide M/A ambulances and ALS to other communities for a price. We bill the community for this not the patient. If the patient is transported by us, then they're billed for it as any patient in our bus is billed, but the town is also billed for a transport call. This keeps communities from over-using us to provide EMS cheaper than they can. We found that when it didn't "sting" they continued to push their staffing/financial issues down the road. Now, they're paying the same per call cost that we'd base a full service agreement on. The money earned from this helped us increase staff to more than offset these calls.

[Guest alsfirefighter]

There are ambulance services that also charge for "NOT TRANSPORTING". If someone refuses to be transported, they sign the wavier requesting no transport (they didn't call for the ambulance). And a few weeks down the road, a bill shows up for Not Transporting.

I'm not understanding what your point is or what you're attempting to convey. Anyone can RMA that is of sound mind and not a minor. Sometimes things are 3rd party calls. But if you call and RMA...you received services...hence in some areas you get a bill for a reduced amount. Just the same that there are those that bill for ALS assessments. You get evaluated by a Paramedic and he turns it over to BLS...again you received a service. You can go to the ER and sign yourself out but if you registered...you're getting a bill.

Also there is no "waiver" requesting no transport. I can request a million dollars..it doesn't mean I'm ever going to get it. It is a refusal of medical treatment and/or transport. I have patients sign them when they are transported but refuse any of the treatments I wish to give. Its their right...but they are in fact refusing treatment. RMA's are the often the highest percentage of litigation against providers.

[EMTBrian 4]

What do most EMS agencies charge for transport (ALS & BLS)? Do they also charge per mile driven? If so, how much? Who is in charge of the rate being charged? The reason why I am asking is because a local agency is trying to boost the price.

Thanks in advance.

Obviously if "Health Insurance" is being billed, the agency has to negotiate with insurance companies, to give them the opportunity to accept or decline their increases.

Its not something that can happen overnight.

[EMTBrian 4]

I am by no means an expert in EMS billing, but it is my understanding that the EMS agency itself sets its own rates. This is typically done via whatever governing body the agency operates under (i.e. Board of Directors, Ambulance Authority, etc.) Typically there is also a charge per loaded mile (when a pt is onboard). Now there may be some places where this is not the case.

Most insurance carriers along with Medicare/Medicaid have their own reimbursement rates for ambulance services. These rates are what they will actually pay for whatever service has been rendered.

So an ambulance service could charge $1,000 for a BLS ambulance transport. If the insurance only pays $500 for a BLS transport, then the ambulance service can either accept that as payment or bill the patient for the balance. All ambulance services that I'm familiar with that do "subscription drives" will waive that balance for those who purchase those "subscriptions".

Like medical providers, ambulance companies are not exempt from the process of providing insurance benefits to the patient who goes by ambulance, be it an non-emergent interfacility

transfer or emergency transportation. These companies have to meet certain criteria and it also involves negotiating an agreed amount, based on type of call, and mileage.

[ny10570 745]

Obviously if "Health Insurance" is being billed, the agency has to negotiate with insurance companies, to give them the opportunity to accept or decline their increases.

Its not something that can happen overnight.

In NY, any negotiation happens with insurance carriers well before any transport and isn't all the common with EMS. Generally EMS bills and the Insurance company pays their standard rate. As long as it is a reasonable and accepted payment the EMS agency must accept it. The patient is then only responsible for their deductible or co-pay.