What is EMS Billing?
Emergency Medical Services (EMS) billing is a service that manages fees for ambulance transport to a hospital or facility accompanied by an EMT and/or paramedic crew.
What types of fees are charged?
- Base Rate – The base rate is determined by the level of service provided and whether the response to the patient is emergency or non-emergency (scheduled). The base rates are as follows:
- BLS (Basic Life Support) Transport – This level of service includes “basic” or minimal treatment and the monitoring of vital signs. BLS transports are staffed by EMTs (Emergency Medical Technicians) The staff of a BLS level of service is not permitted to perform any action that breaks the skin of a patient. The reasons for this level of service are generally dispatched for non-life-threatening conditions.
- ALS (Advanced Like Support) Transport – This level of service has a paramedic present, along with an EMT (Emergency Medical Technician). The transport will provide services such as, cardiac monitoring, continuous IV drip, and certain types of medication administration.
- ALS2 Transport – In addition to the ALS services, this level of service includes medication administrations by IV push/bolus or infusion and at least one of the following ALS2 procedures:
- Manual defibrillation/cardioversion
- Endotracheal intubation
- Central venous line
- Cardiac pacing
- Chest decompression
- Surgical airway
- Intraosseous line
- SCT (Specialty are Transport) – This is the highest level of transport for critically injured or ill patients by a ground ambulance. The ongoing care of one or more specialized medical professionals, along with specific medical procedures necessitates the need for an SCT.
Why is the patient’s signature required authorizing the EMS provider to bill insurance?
- Consent to treatment and transportation
- Provider authorization to bill insurance on the patient’s behalf
- To assign your insurance benefits to your EMS provider, allowing your insurance to pay your EMS provider
Does insurance cover ambulance transport?
- Medicare – Medicare is a government insurance plan that will generally cover all emergent, medically necessary transports to the nearest appropriate medical facility. For an EMS transport to be considered medically necessary, the use of any other form of transportation must be considered hazardous to the patient’s health or current condition.
- Medicaid – Medicaid is also a government insurance plan but is administered by the state. Coverage of EMS services varies from state to state, so it is important for the beneficiary to familiarize themselves with their individual benefits.
- Private Insurance – Private insurance also varies from policy to policy. The beneficiary is responsible for understanding what their individual plan covers. The beneficiary is also responsible for out-of-pocket expenses assigned by the plan including copayments and deductibles.
- Auto Insurance – Personal injury protection (PIP), uninsured motorist coverage, and comprehensive auto insurance will cover ambulance transportation if it is deemed medically necessary.
What if I do not have insurance?
If a patient does not have insurance coverage, the charges for the base rate, mileage, and any procedures, supplies, or medication used will be due from the patient. EMS providers may provide discounts and/or payment plans.
Can I be billed if I refused transport?
Yes. Even though you may not have been transported in an ambulance, you may still be billed for the activation of the 911 system. There is a significant cost resulting from the response of emergency medical personnel. Even if a patient refuses transport, they were still a recipient of EMS services the responding agencies. Furthermore, if a police officer or good Samaritan activates the 911 system on a patient’s behalf, he/she is not held responsible for the services the patient received.
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