“We’re being pressured to improve our collection rates. What’s a reasonable goal?”
There’s no single answer; every EMS service is different, so a “reasonable” collection rate in one system might be out of reach for another. Improving your collection rate is still possible, though, beginning with a review of billing collection processes, payer mix, rates and revenue flow.
Some things to consider during the EMS billing process are:
1. Medicare pays EMS BILLING on a fee schedule
Its published allowable reimbursement rates are listed on the Centers for Medicare and Medicaid Services website. A service should have charges that are no lower than these rates. Most commercial insurance companies have reimbursement rates that are much higher than the Medicare Fee Schedule rates. If you are only billing at the Medicare Allowable, you could be leaving money on the table.
2. Timely follow-up is a key factor in successful collection of EMS BILLING accounts
Many payers now have online access to allow providers to review claim status. Other methods include automated voice response systems, allowing you to obtain claim status over the phone. Finally, a call to customer service can help push a claim through. If you’re not following up on a static claim, chances are no one else is either.
3. Co-insurances, deductibles, balance after insurance and uninsured patient balances can be the hardest to collect
For many services, this category typically makes up 10 percent to 15 percent of the payer mix. Pursuing balances associated with these categories takes up precious patient account representative time. Using automated statements and dunning letters can be an effective way to handle these balances while allowing staff to focus on pursuing claims with insurance companies.
4. Some services don’t like the idea of using an outside collection agency
While we highly recommend doing so, it’s not necessary if you have the resources and are willing to pursue these balances in small claims court. While this may seem harsh, if a service is not pursuing patients who will not pay, it is providing a disservice to those who do, because the cost of service will have to increase to make up the difference.
5. Helping patients enroll in government assistance programs
Assisting patients who want to enroll in payment assistance programs, such as Medicaid, is another way to potentially increase your collectible revenue while also providing quality customer service to your clients. Applications for assistance are available on most states’ Health and Human Services websites. Print and mail an application to a patient if requested. An offer can be made to help them fill the application out over the phone and then mail it to them for review, signature and mailing. This can make the difference between getting paid something or getting paid nothing at all.
If you’re considering the above factors and following the steps described, in addition to such basic necessities as doing good documentation to begin with, your collection rate is very likely “reasonable” — or close to it.
This article, which was originally published on April 10, 2012, has been updated.
