The 43-day shutdown of the U.S. government in October and November 2025 complicated lots of things for lots of people, and that included the operation of ambulance organizations that rely on federal reimbursement of their services to Medicare patients.
The day before the shutdown began, the temporary ground ambulance add-on payments provided by the Centers for Medicare & Medicaid Services (CMS) lapsed. Many EMS organizations rely on those payments – an extra 2% for urban services, 3% for rural and 22.6% for super-rural – to help offset regular reimbursements that don’t meet the costs of providing service. With government not functioning, those payments were not immediately restored.
Medicare reimbursements didn’t stop, but CMS had its contractors place holds on claims submitted while it continued. This was intended to provide some breathing room if the shutdown was short. It wasn’t, and contractors ultimately had to pay claims from October 1 and after at the statutorily required base amounts – which didn’t include the add-ons. That was a small but significant blow at the margins for many services that operate without a lot of breathing room.
The shutdown also created uncertainty and administrative disruption across federal health programs and with the “extenders” – for instance, telehealth and home-hospital care waivers – relied upon by many EMS and hospital providers. Medicaid funding generally continued, but providers and states faced uncertainty and delays in some functions.
How fragile is your cash flow?
The spending package that finally ended the stalemate restored the ambulance add-ons retroactive to October 1, so services didn’t end up losing any income when all was said and done. But the experience underscored the fragility of many EMS organizations’ cash flow and how easily it can be disrupted.
“The shutdown impacted some of our customers pretty significantly,” said Stacey Bickford, senior product manager for ZOLL Billing, the advanced billing and revenue-management software offered by ZOLL. “Medicare typically makes up around 50%–60% of EMS providers’ business, so they were holding a lot of claims waiting for the legislation to go through, and we saw customers with some delays in revenue due to that.”
For some services, other factors compounded those hurdles. Tariffs added a less-direct hit for many through higher vehicle costs, manufacturing delays and pricier medical equipment and supplies, and inflation nibbled away at purchasing power. The result was a tough year of, once again, having to do more with less – a familiar ask for EMS and ambulance providers.
When that ask is so regular, optimizing reimbursement and the flow of cash in exchange for services becomes essential. The time- and labor-saving features of ZOLL Billing were developed to help organizations do that.
“The more claims you can input and put through with fewer resources, the better,” noted Bickford. “The job market out there is still a bit squishy – it’s hard to find qualified staff, especially folks with the right experience to process claims. One of the things our customers really enjoy is that we can walk them through a recommended workflow and give them guidance along the way: What’s the proper process for completing this claim? Do you have all the information you need on it? Are you using the resources you have to best assess the level of service and charges?
“ZOLL Billing is a really good product for customers who may not be sure what those configurations need to be. We can suggest the proper time frames and workflows to help those customers who don’t necessarily have in-depth billing knowledge and may need some guidance to help run their collections efficiently.”
That high degree of engagement and support for EMS billers supplements a suite of advanced features that streamline and facilitate the billing experience.
Tools improve the claims process
Driving claims through the billing process has historically been slow and labor-intensive. Coding had to be accurate and documentation sufficient; payers often have different requirements; and claims had to be manually batched and prepared. With the automation of key workflows and built-in tools to optimize accounts receivable, ZOLL Billing helps ensure accuracy even as billers process more claims faster with existing resources.
The integration of ZOLL’s RCM optimization tools provides automated real-time capabilities to verify and enhance patients’ demographic information; track down their primary and other insurance coverages; confirm their eligibility and determine any outstanding deductibles (plus patients’ ability to meet them). Charges and payments can be organized by accounting period and remittances imported automatically. ZOLL Billing supports additional documentation and comes with an array of built-in reports and analytics that provide key insights.
The cloud-based software eliminates IT overhead and administrative costs. This also allows automatic updates to both software and key data like Medicare fee schedules, and billers can work from anywhere, using the internet-enabled computer of their choice.
ZOLL Billing supports natural workflows and a smooth, efficient claims process that lets organizations boost their productivity and actual collected revenue. It also provides them enhanced visibility into the revenue process and a clearer idea of anticipated payments.
“In general, in EMS, we know we’re going to bill a certain amount, but that doesn’t mean we’re going to get that much reimbursed,” said Bickford. “I can bill Medicare $50,000 for an ALS emergency, but I may only be paid $430 based on my location, so being able to see the expected reimbursement is critical to getting an accurate net due amount. A customer can know and recognize that they’re going to get around 40% of the amount billed in certain cases. Businesses need that type of transparency to operate efficiently and plan ahead.”
Experience meets expectations
The city of Bend, Oregon had been a user of ZOLL’s RescueNet solution suite, which integrates communications, patient care documentation and billing/administrative workflows, since 2010. Its move to RescueNet from a 1980s-era AS/400-based system improved its operations and collections and served the city and its fire-rescue department well for 15 years.
“It allowed us to keep track of our outstanding charges versus the revenue coming in. Matching those required a manual process before,” recalled Kindra Harms, who’s led the city’s ambulance billing since 2000. “Bend grew so rapidly, and our call volume increased so rapidly that RescueNet allowed us to stay current.”
From 2010 to 2025, however, Bend’s population jumped by another 40%, and while the city added billers, it had still fallen four months behind by last spring. Filing deadlines started to be missed, and revenue was written off.
Harms had been pushing for a move to ZOLL Billing for years, arguing the upgrade would save money through enhanced automation and preventing such write-offs. In May 2025, she got her wish.
“I saw what cloud-based software would allow us to do,” she said. “Things had gotten kind of piecemeal. We had a clearinghouse from a different company. We had the add-on features for insurance discovery. All the pieces weren’t talking to each other, and we were having to go to different platforms to get the job done. I knew ZOLL Billing had the ability to just do it all in one.”
Through the platform’s first half-year, experience met expectations. Key features that have been especially valuable are ZOLL Billing’s insurance discovery function and an automated data import/export ability that came as a pleasant surprise. If a patient’s already in the city’s database, their information can be automatically pulled in and reconciled.
“That was something we hadn’t considered before,” said Harms. “We were hand-entering data into RescueNet from the first letter of someone’s first name all the way through. Now we have that export and import automated and have those patient demographics just drop in.”
That averts errors and helps ensure accuracy, especially when connected to hospital data. It’s a common problem in EMS that different crews that see the same patients may, absent formal IDs, enter their names differently – John vs. Johnny vs. Jonathan, for instance. If their demographics are comparable, ZOLL Billing can automatically identify the possible match.
It also automatically attaches a PDF of the crew’s ePCR, which previously had to be attached manually. That saves opening the document to verify its signatures.
Another unanticipated benefit came from the platform’s ability to monitor patient deductibles and delay sending claims when a deductible likely hasn’t been satisfied. Instead of filing immediately and risking denials or leaving the patient with debt, the system monitors the deductible, then submits the claim at the optimal time.
“Once we got caught up with our billing backlog, we started to get so fast that we were being denied for the deductible,” said Harms. “I think that ‘hold for deductible’ feature is pretty awesome.”
Bend sees the benefits
For billing in Bend, all those little time savers have added up. Harms’ office no longer needs the fourth full-time employee that once seemed inevitable. With some of the time the other staff have gotten back, they’re conducting “bill-along” training for EMS clinicians to emphasize the importance of their documentation to the revenue process.
Most important, revenue has improved, write-offs have stopped, and bills are getting to their responsible parties in a way that’s faster and more accurate than ever.
“Our billing process is now extremely efficient: We’re able to submit claims just six days after the transport,” said Harms. “That level of timeliness is fantastic, though it does mean the patient might still be in the hospital when the billing process begins!”
For more information, visit ZOLL.
