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Volunteer EMS: 10 things to know about billing for services

Not billing for EMS patient transport leaves money in the pockets of insurance companies and government programs created to pay for ambulance transport


Volunteer agencies have been struggling to make ends meet for years, and attempting to raise funds through bake sales and BBQs instead of accepting money that has already been collected makes little sense in today’s economic environment.

Photo/National Park Service

Volunteer agencies have been struggling to make ends meet for years, and attempting to raise funds through bake sales and BBQs instead of accepting money that has already been collected makes little sense in today’s economic environment.

In order to successfully implement a billing program, volunteer agency leaders need to know these 10 things about billing.

1. Why the sudden need for billing?

Call volume and operational costs have risen dramatically in the past 10 years, and often paid EMTs fill shifts when volunteers are not available. The lack of funding is causing critical failures in response time, availability of continuing education, and replacement of outdated and unsafe equipment.

Patients are already paying for health care through private insurance premiums and their taxes. No EMS agency can afford to leave money on the table, and insurance revenue is the low-hanging fruit of EMS funding.

2. Buy-in must be obtained from the entire membership

Seventy percent of all organizational change efforts fail. One reason for this is leadership simply does not get enough buy-in from enough people for their initiatives [1]. Take the time to make your members feel comfortable and positive regarding the process.

Stress that uncollected insurance — private or government — payments only increases profit for the insurance companies. Billing will help the volunteer service to survive, provide excellent care and reliable response.

Explain NEMSIS to your members and that revenue collection is only one of the benefits of billing. Continuum of care, development of treatment modalities for the future, demographics, patient outcome data, crew makeup and response time data allows for best practices based on evidence versus theory.

Using ePCRs and participating in data collection is critical to the future of EMS, especially for volunteer services. Numbers matter, and obtaining federal, state, local and grant funding is based on the ability to provide a compelling story based on facts, not just emotion.

3. Haters are going to hate

There will always be people who complain or condemn a volunteer EMS service for billing or claim the service is no longer volunteer because true volunteers have always provided the service for free.

Organization leaders and members must be informed and prepared to answer questions from people in the community regarding billing practices and explain that this is beneficial to the community and EMS as a whole. Be ready to accept and overcome negative feedback for a while.

4. Without quality education, you will lose people you can’t afford to lose

A qualified professional educator should provide members training on the use of modern ePCRs, which are critical for collecting information for billing patients. Some members may need an introduction to the use of computers for data collection and reassurance and mentoring to overcome fear of this new process.

Some EMTs may push back because they have not been taught the importance of documentation for billing and data collection. How to work documentation into the choreography of every call is a skill that needs to be added to the EMT toolbox.

5. New rules may apply

Clearly explain that when you bill for service, you are bound to maintain or meet state regulations for a legal crew, regardless of what tradition or local ordinance has previously allowed different staffing configurations.

6. The community needs education and reassurance

Be very clear that ambulance service will always be provided regardless of ability to pay. Explain ALS versus BLS transport and treatment, bundle billing, what constitutes a 911 emergency and what calls are routine transfers. Make sure members and local decision makers understand transport necessity as viewed by Medicare.

Guarantee that a system will be in place to assist any of your neighbors with a financial hardship are able to write-off, reduce or form a reasonable payment plan.

Provide reassurance that all EMTs are educated on HIPAA and personal information will be protected.

7. Outsourcing is usually better than attempting in-house billing

When implementing billing, department leaders need to consider the cost of billing and accounting software, the training and ongoing time commitment for already strained members, and level of accountability necessary.

Never hire someone to handle money that you are not prepared to fire if performance or integrity comes into question. In other words, don’t hire the chief’s sister-in-law or Suzy the long-time volunteer who is retiring from the field and needs a job, but has little or no accounting experience.

8. Do your homework when choosing a billing company

Don’t just choose whomever the neighbor agency is using. Make an informed choice. References and testimonials should be readily available.

Be clear on costs and how the billing service gets paid. Is it a percentage of collections, per run sheet or a flat rate plus percentage? What is the turnaround time for revenue collection?

Beware of hidden costs. Who will do the quality assurance or pre-billing review? What additional cost is involved with documentation issues that need to be fixed, such as missing demographics or signatures? Who answers the billing questions from patients?

Like many purchasing decisions, it is usually possible to receive a better rate if multiple agencies form an alliance and hire a single vendor. Aligning with a neighboring agency might create or build on an existing collaboration for supply purchasing, ambulance purchasing, fleet maintenance or training.

9. Leaders must provide assistance and prevent volunteers from being overwhelmed by the new procedures

When choosing a billing service, it may be worth paying a little more for a higher-level of customer service and multiple training opportunities than going with the cheapest quote, which might not include initial or follow-up training. A dedicated training team should be in place for the startup and be available for at least the next six months to a year. This will minimize frustration with the billing and ePCR system and help ensure the desired results are achieved.

10. Include local and state government officials in the process

Be aware of and ask for help overcoming any legislative obstacles, such as inability to bill insurance companies directly or language in local or state legislation preventing volunteer agencies from receiving payment. Historically, it is difficult to collect payments that have been sent directly to the patient.

Explain why the billing revenue is needed and how the money will be used for system improvements, new equipment, improved staffing and continued education. Be forthright about what kind of oversight is in place to ensure funds are properly managed. Transparency will garner and maintain much-needed political support.

1. Cracking the Code of Change. Harvard Business Review. May-June 2000.

This article, originally published on March 3, 2016, has been updated.

Nancy Magee combines a business woman’s perspective on marketing, efficiency and customer service with an EMS volunteer’s heart. Nancy, a Connecticut native, now resides in Louisiana and offers her Volunteer Survival Series workshops and consulting services through MEDIC Training Solutions to agencies across the country. Contact Nancy at