Friday, July 11, 2014

Adding EMS Routines? 3 Key Questions to Ask Prior to Taking the Leap

Increase volume. Increase cash flow…not so fast!
As an EMS billing contractor, we increasingly are contacted by our clients about the pros and cons of adding routine/non-emergency ambulance transports to the daily repertoire.

It’s a big decision. It’s a decision that should not be entered into without a lot of thought and careful consideration.

Ask before leaping
While, on the surface, it would seem like any increased run volume will translate into increased cash flow, which may not be the case.

Take a step back, run the numbers and ask these three questions before you even get started.

1. Do we have a reliable referral source(s)?
Routine transports are not going to magically appear.

So if you are thinking about jumping into the EMS non-emergency transport arena have you connected with a referral source for ambulance runs to be funneled to you on a regular basis?

EMS agencies that are successful with this side of the business always have reliable referral sources locked down, preferably under contract, before they begin taking these types of trips. Your up-front task is to visit with some probable individuals who represent facilities and who are in the position funnel EMS runs to your agency as one of their preferred service providers.

Cultivating and maintaining these sources can be tricky. Do your homework.

For example: is you EMS agency number 56 to serve this facility in the last three years? If so, has the facility used and abused other agencies and your department is just going to be one more in a long line of dissatisfied service providers? Does the facility owe the other 55 agencies beau coup bucks that will never be paid and they are now looking to your agency to now provide a year or two worth of transports only to stick you for the majority of the runs and then move on to the next service?

Beware! It happens.

2. Who are the other EMS players in the market?
This is a very important question to ask on behalf of your department.

Let’s say your agency is a secondary player in the market. Your agency is the local 9-1-1 service and you’ve had to add career staff to supplement a waning volunteer pool.  The idea of adding routine transports is to help offset your new, additional payroll costs.

However, down the road is a pretty large, not-9-1-1 EMS agency who has three times the vehicles you have, offers wheelchair van services and can pick-up runs at a moment’s notice unencumbered by 9-1-1 calls.

You think the other service is being kind by allowing you to get in the game, however what they are really doing is funneling their crumbs to you by default. You know… your agency winds up taking the long-distance, self-pay run they turned down while they pick-up the 2-mile-down-the-road, commercially insured patient transport that almost insures a nice, dollar return. Meanwhile, your billing office will struggle to collect on your transport in $5 dollar increments over the next 100 months.

Not cool! The routine game’s success is not measured in quantity…it’s measured in quality.

3. Are the runs going to include reasonable transports for medically necessary patients?
Of the three questions we’ve challenged you with today, this one is the most important.

First, be sure you understand all the rules and regulations and most importantly that you know the definition of what constitutes a reasonable, medically necessary transport in the eyes of Medicare, Medicaid and other Commercial Insurance payers.

We’ve blogged numerous times and consistently about the viability of transports of ESRD patients to and from dialysis facilities for treatment. CMS is working hard to drive home the point that these patients do not require ambulance transport (at least most of them) and have even cut the payment rate.


If the bulk of your routines are hospital discharge in nature; beware! CMS has also issued numerous communications stating their opinion about their negative feelings toward these trips.

Also remember, transports to physicians’ offices are not covered by most payer sources as these destinations do not meet the rules for payment by Medicare (as Medicare pays so do many other insurance payer sources.)

Think before you leap!
Don’t just jump in. Think before you take the big leap!

Your agency’s goal is to offset costs not create more financial strain. Plus, it’s not just a money issue. Consider the strain these transports may place on your staff (do we need to add more people?), vehicles (do we have enough vehicles to honor our commitments?) and overall resources (will we be dropping 9-1-1 emergencies while completing routine runs?)

Use your billing office as a resource when scoping out your possibilities. Enhanced is here to help. Contact us today if your billing office isn’t providing the support you need when making this kind of decision. Our clients can tell you that they can call us anytime for guidance and direction. It’s what we do!

Chuck Humphrey is waiting to hear from you. Contact him from our website at, via e-mail to or toll-free at (800) 369-7544, Extension 108.
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