EMS Solutions FAQ

1. Basic Life Support (BLS)
2. Advanced Life Support (ALS)
   • Level 1 (ALS1)
   • Level 2 (ALS2)
3. Specialty Care Transport (SCT)
4. Paramedic Intercept (PI)

EMS software as a service for dispatch, patient care reporting (ePCR), and EMS billing software, including dedicated customer support, maintenance, and security.

EMS billing services and expert guidance, including outsourced EMS billing services, billing assessments and consulting, Revenue Cycle Management (RCM), and short-term billing service help.

For emergency calls, when a caller dials 9-1-1, the phone number from which they call determines which 9-1-1 center receives the call for assistance. Cell phone calls are processed based on the closest cellular tower. Once the dispatcher analyzes the EMS situation, they will notify the closest appropriate EMS agency for response. Many 9-1-1 centers communicate with the EMS agencies via computer-aided dispatch software.

Scheduled and non-emergency calls do not get dispatched through 9-1-1. Rather the referring hospital, skilled nursing home, or other caretakers or facilities will coordinate the transport directly with the EMS agency. Dispatch software is often used as a tool to coordinate schedules between facilities and EMS agencies.

Paramedics follow state and local guidelines for prioritizing and assigning clinical priority. In general, they follow a system that categorizes emergencies by:

Critical: Critically ill or injured person requiring immediate attention
Urgent: Less serious condition, requiring emergency medical attention but not immediately endangering the patient’s life
Non-Urgent: Non-emergency condition, requiring medical attention but not on an emergency basis

1. Fire-Based EMS
2. Third-Party/Private EMS
3. Hospital-Based EMS

AIM’s dispatch software gives you complete control of every transportation process. Track locations and statuses, ensure quick responses, improve patient satisfaction, facilitate better communications with 9-1-1 centers and facilities, automate tasks that require manual labor to schedule calls, get mobile access and a real-time view of current and scheduled transports, set up automated alerts and notifications about calls and crew members, plus receive quality customer support focused on the success of your EMS agency.

Medical billers want a billing software that is dedicated to the type of billing they specialize in. Ambulance billing involves a level of complexity that most medical billing software is not equipped to handle. Unlike billing for other medical specialties, ambulance billing is not based on a single diagnosis, rather it is based on the patient’s apparent condition. Coding and billing are done based on the patient care report, which includes critical information about how the patient was found on scene, assessments results, procedures performed, medications administered, mileage, and so much more. The patient care report must clearly support the medical need for the transport and explain enough detail to determine the level of services that can be billed (BLS, ALS) and the number of loaded miles that can be billed. A billing software that specializes in EMS billing helps ensure claims get paid right the first time.

The RCM process or full-cycle medical billing for ambulance transports begins when the ambulance leaves the station and ends with successful payment collection. However, there are many steps between that must be accurately and efficiently completed to ensure timely payment. These steps include gathering supporting documents, such as the patient care report and medical necessity documents, insurance verification, medical coding, charge entry, charge transmission, AR calling, denial management, and payment postings. All of these steps may be handled by one dedicated biller or split across multiple functional experts depending on the size of your EMS agency. No matter your size, you want to make sure you have an EMS billing software that can manage the RCM process from start to finish.

Cashflow is the backbone of every business, and the healthcare arena is no exception, including EMS. The collections process in EMS billing should be managed in a billing software that is built for billing ambulance transports and has automated processes built in to manage transmitting bills and receiving payments. The software should include features that make the payment process as easy as possible. Software will not make a difference, however, if you don’t have the right staff in place to handle collections. EMS billing staff training and experience is critical to the success of your collections. Ideally, you want to work with an EMS billing software vendor that can not only train on the software but also assist you with the coding and billing practices unique to EMS.

The best EMS software includes features that not only increase the accuracy and speed of coding and transmitting ambulance bills, but also help keep you HIPAA compliant and secure from cyber threats. You need an EMS billing provider that specializes in EMS billing, providing you with a level of support that exceeds just the general understanding of how to use the software. It should also explain how to properly bill ambulance claims and work with common EMS payers like Medicare and Medicaid to make sure your EMS agency is set up properly.

AIM specializes in EMS billing services and billing software and offers a wide range of services that are focused on maximizing your ambulance billing reimbursement. Services include outsourced EMS billing services that focus on the complete revenue cycle management process, as well as personalized EMS billing consulting services focused on helping agencies with internal billing staff produce quality work in an efficient manner. AIM also provides interim billing help if you are in a situation where you are not ready or willing to give up the entire billing process, but you need help getting through backlog or recovering from an unforeseen staffing issue.

ePCRs are documentation that provide a clear clinical picture of the patient's needs. They must include, but not be limited to, the documentation of the event or incident, the medical condition, treatment provided, and the patient's medical history. The primary purpose of the Patient Care Report (PCR) is to document all care and pertinent patient information as well as serve as a data collection tool. An Electronic Patient Care Report (ePCR) is an electronic version of the paper patient record.

An ePCR makes patient care report data consistent, retrievable, and reportable for billing, quality assurance, state and national (NEMSIS) reporting, and other improvement initiatives.

Documenting patient care information electronically makes it easier to capture, share, monitor, and analyze patient health data at a local and national level, which all works toward improving patient outcomes.

ePCR features should make it easier for crews to communicate with dispatch and receiving facilities.

The main users in an ePCR software are crew members, including the EMTs and paramedics that document the patient care. Other non-crew users include quality assurance staff assigned to review the ePCR records, medical directors that want to analyze certain call types, and management authorized to view and analyze ePCR reports and analytics.

Electronic patient care reporting helps EMS agencies effectively maintain control over patient care data. Without it, more time is spent tracking down what is needed to bill for reimbursement. It makes it easier to share important data, whether for an audit request or state and national data requests. Integrated ePCR solutions also make it easier for crews to communicate with dispatch, QA, and management. It allows for automated analytics and reports on key performance indicators, making it easier to identify shortfalls and correct them quicker.

AIM offers ePCR software, a cloud-based solution that can be used on a tablet, smart device, or computer within the ambulance. The ePCR is easily integrated with AIM dispatch and AIM billing, as well as other third-party vendors to help save time. It is built to improve the quality of a PCR while providing configurations that ensure crews don’t spend a ton of time completing a report. This solution is supported by a customer success team devoted to an EMS agency and its success.

Unlike medical billing, ambulance billing involves a level of complexity that most medical billers don’t understand. Unlike billing for other medical specialties, ambulance billing is not based on a single diagnosis, rather it is based on the patient’s apparent condition. Coding and billing are done based on the patient care report, which includes critical information about how the patient was found on scene, assessments results, procedures performed, medications administered, mileage, and so much more. The patient care report must clearly support the medical need for the transport and explain enough detail to determine the level of services that can be billed (BLS, ALS) and the number of loaded miles that can be billed. A billing software that specializes in EMS billing helps ensure claims get paid right the first time.

Medicare Part B covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services and transportation in any other vehicle could endanger your health. Medicare may pay for emergency ambulance transportation in an airplane or helicopter if you need immediate and rapid ambulance transportation that ground transportation can’t provide.

Outsourced ambulance medical billing has several benefits. It helps you increase the efficiency of your emergency team by freeing them from the hassles of handling EMS billing. It can also free up resources helping you lower overall operational expenses. At the same time, it improves the quality of your billing and time to reimbursement because you have a team of EMS billing experts with a sole focus on understanding the latest EMS billing and compliance practices. Add to this the high level of security and availability, and you can easily see why so many ambulance services outsource their billing.

EMS revenue cycle management (RCM) consists of administrative and financial processes that help mitigate common gaps from dispatch to discharge that contribute to revenue loss. These processes also help to uncover opportunities to save money and cultivate cashflow. Understanding every step of the EMS billing process, where delays may occur, and where opportunities may arise is the root of RCM.

1. Pre-billing steps include automated insurance verification processes that get ambulance claims to the correct payer quickly.
2. Coding steps accurately identify the level of emergency medical services provided and ensure your EMS agency is properly reimbursed for services rendered.
3. Billing procedures lead to rapid turnaround on electronic claims transmissions, ambulance claim denials and appeals, and attorney and payer requests.
4. Collections processes ensure continuous follow-up on open patient accounts receivable (A/R) and include statement and aging cycles designed to meet your EMS agency’s specific needs.
5. Payer contracting processes are established and maintained when it makes good financial sense for the EMS agency.
6. Provider enrollment assistance reduces time and frustration with application completion.
7. Data analytics support the development of a high-quality and efficient EMS billing workflow.
8. Management and oversight of your EMS billing should include a dedicated account lead and EMS billing specialist.
9. Compliance processes maintain the latest local and federal regulations through AIM’s free NEMSIS-compliant ePCR software.
10. A continuous drive to improve on current RCM workflow is always necessary.

With an effective RCM workflow, EMS agencies can keep costs down and focus on improving patient outcomes. When an integrated billing and coding system is implemented, ambulance providers can achieve higher rates of error-free claims and fewer past due payments, resulting in higher revenue and profits.

HIPAA laws protect all individual identifiable health information that is held by or transmitted by a HIPAA covered entity or business associate.

If you are HIPAA compliant, you have done what’s needed to satisfy the requirements set by the Security Rule, you have policies and procedures in place to address the elements, you are knowledgeable in HIPAA as it applies to your agency, you document your processes and version control them, and you create an ongoing training program to ensure your agency remains HIPAA complaint.

The penalties for HIPAA noncompliance are based on the level of negligence and can range from $100 to $50,000 per individual violation, with a maximum penalty of $1.5 million per calendar year for violations. Some severe violations could result in actual jail time.

The Healthcare Insurance Portability and Accountability Act requires that a person within a covered entity or business associate is assigned the duties of a HIPAA Compliance Officer. This may be an existing employee or a new position.

Protected health information, or PHI, according to HIPAA regulations is identifiable health information that a covered entity or a business associate uses, maintains, stores, or transmits as a part of healthcare services. ePHI is electronic protected health information that is held or transferred in electronic form.

AIM is committed to satisfying the requirements set by the Security Rule and has policies and version controlled documented processes in place to address each element of the Rule. AIM’s billing experts are knowledgeable in HIPAA as it applies to EMS, and AIM’s dispatch, ePCR, and billing software solutions are backed by our external data center, which is registered with Cloud Security Alliance (CSA) Security Trust Assurance & Risk (STAR) Registry and is SOC certified. We provide ongoing training to all our staff to ensure HIPAA compliance and pass this knowledge along to our customers.