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Should you outsource your ambulance billing or keep it in house?

Weigh the pros and cons of partnering with a billing partner to maximize your revenue


Sophisticated ambulance billing software often comes with reporting features that can give you a clear overview of how claims are processed and which transports are not being paid for.


Sponsored by Sharp Ambulance Billing

By EMS1 BrandFocus Staff

For some EMS leaders, ambulance billing issues can be a headache. Ambulance billing and reimbursement can be complex, but that doesn’t mean that it has to continue being one of the biggest challenges that your organization faces.

One of the most important questions you should ask yourself is whether your EMS billing operations are efficiently maximizing revenue while also meeting compliance standards. In fact, it can be extremely costly for you to overlook the finer points of your EMS billing operations.

When EMS decision-makers take a closer look at their agency, a frequently asked question is: Should I outsource my EMS billing or keep it in house?

Companies like Sharp Ambulance Billing can help EMS providers with all of their billing needs.

Here are some of the pros and cons of outsourcing your billing services:

PRO: Access to billing and coding experts can maximize revenue

If your agency is in a rural area, finding qualified talent to handle your billing needs can be difficult. Even if you filled those positions, expecting your staff to be fully on top of constantly changing payer requirements and compliance rules can be a challenge in itself.

That being said, it’s not surprising that one of the most common mistakes EMS leaders make is to assume that they’re maximizing their revenue just because they are getting paid the same amount every year.

Barry Christian, co-owner of Sharp Ambulance Billing, said it’s especially important for EMS leaders to demand transparency from their billing team on the number of bills that didn’t get paid, as well as a clear explanation on what could have been done to get those claims paid.

“I’ve found that 90 percent of EMS agencies I talk to admit that they can’t even get that kind of information from their in-house billing team,” said Christian.

One of the benefits of outsourcing your EMS billing to another firm is that they can offer your agency the necessary expertise and insight, which becomes one less thing for you to worry about.


Sophisticated ambulance billing software often comes with reporting features that can give you a clear overview of how claims are processed and which transports are not being paid for. What’s more is that the software can also help you automate some processes in a way that lets your agency process claims faster than ever before.

But in-house billing teams often don’t have access to this kind of software due to costs.

“When you know you need tools like reporting and automation to make the billing process more efficient, bringing your billing in house to save money may not be the best move because you end up collecting less and spending more,” said Christian.

Access to billing software that’s easy to use is another benefit of seeking outside help from a billing services company. Plus there’s no need to worry about keeping up with IT requirements, staff training or other costs associated with implementing a billing services platform.


By outsourcing billing, you have more flexibility to make changes, since sometimes all it takes is switching billing companies.

When you’re choosing a billing partner, it’s important to consider how the size of the billing company can affect your collection potential. Larger billing companies may overlook opportunities, especially smaller or complex claims, to save the costs associated with further investigating an unpaid bill.

Larger billing companies tend to focus on profits and volume, meaning that they usually automate systems and processes for easier claims, said Christian. This means they spend less energy on recouping the harder claims, so those more complex claims can end up becoming lost profit.

“It’s what I like to call budget dust, where claims worth nickels and dimes are not really worth it for these larger companies to pursue because they can just become more profitable by addressing the low-hanging fruit,” said Christian.


Sometimes having the ambulance billing staff in-house is a better choice. One benefit of having your billing services conducted in house is that your staff’s only priority is your company’s bottom line.

Your own staff is more likely to attempt to address complex unpaid claims, but they may lack the tools to be able to address them in an effective manner.

“There’s often a productivity issue with in-house billing departments with a small number of staff because they often do not have the systems or knowledge to make the most out of each patient transport claim,” said Christian.


Another benefit of keeping your billing services in house is that your staff often has the advantage of knowing your clientele and the local rules that affect ambulance billing in your area.

Often your in-house staff also has existing relationships with your customers. But the ability to build relationships with customers isn’t just reserved for in-house staff. With the right billing partner, agencies can also rebuild or establish relationships with customers while also retaining knowledge of the market.

Working with a billing partner can help your agency maximize collections and revenue. Consider the pros and cons of working with an in-house billing team and an outsourced billing partner when you’re evaluating whether you’re doing the most to increase your ambulance billing profitability.

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