Fraudulent billing is life-threatening to EMS agencies

Although Medicare and Medicaid rules are lengthy and confusing, EMS leaders and field providers must ensure compliance

Paying for an EMS service is a complex and costly proposition. We often do not think about the medical coders and billers who work behind the scenes to make sure that our services are appropriately reimbursed by insurance companies, government agencies and patients.

The rules and regulations that oversee Medicare and Medicaid payments are lengthy, confusing and at times contradictory. Yet EMS billing staff has to navigate their way through the bureaucratic mess and try to recover as much payment as the agency is entitled.

It’s not that the reimbursement rate is huge. Most agencies will report that they barely make enough in insurance reimbursement to cover operating costs. Even publicly-funded agencies struggle to keep the ambulances rolling out of the station, when taxpayers feel that they can’t afford to pay anymore.

As clinicians our focus is on the clinical care and transport of our patients. But we can make that a slightly easier task by working to ensure our costs are covered as well.

Getting patient signatures, ensuring that the documentation is accurate and complete, and completing appropriate paperwork, like Physician Certification Statements, that authorizes transport are tasks that are as important as providing appropriate care.

As this news of forged signatures on Medicare forms indicates, insurance programs show little compassion when something is done inappropriately or illegally. For a small agency, losing nearly $1 million in revenue can be life-threatening.

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