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Billing and reimbursement for services rendered remains a pain point for many ambulance districts, EMS services, and related providers nationwide. Medicaid and Medicare may reimburse only a small portion of services, and large private insurers regularly negotiate their rates and terms, reimbursing only a small portion of billable fees.
Many providers struggle to cover costs and overhead, as payments and reimbursements cover only a fraction of the cost of the service provided. As negotiations and reimbursements continue to be a battleground issue, the Missouri Ambulance Association wants EMS professionals to understand the future of EMS billing and reimbursement and how these trends could impact operational budgets.
Table of Contents:
The Trend of Seeking Outside Funding
Value-Based Payment Models
Policy Reforms at the State Level
The “No Surprises” Act Impact
Healthcare System and EMS District Partnerships
The Trend of Seeking Outside Funding
EMS and ambulance providers seeking outside funding through grants and other financial support is not new. The National EMS Advisory Council (NEMSAC) addressed the trend in a committee report after 2016. One common budget reality that most ambulance districts and EMS providers share is the inability to bill for their response. The report noted that “...Due to the unique nature of the service delivery model, EMS agencies provide an increasing number of responses where no reimbursement is available.”
As the report details, many EMS providers only receive reimbursement when they transport the patient to an emergency room. Other care provided during the team’s response could remain uncompensated, overlooked, and, in some cases, not covered.
When services are rendered but the EMS district (or provider) is either unfairly compensated or not compensated at all, the bill for the care provided falls in the patient's lap. Some costs may be written off for care provided to patients living within the ambulance district that responds to the emergency. Unfortunately, as more districts and EMS providers now operate on razor-thin margins, many cannot afford to write off these costs for constituents/residents.
Grants and other funding opportunities provide additional financial support that ensures districts remain operational even as they struggle with low reimbursement rates. As operational costs rise and reimbursements decrease, more districts and EMS providers will seek outside funding.
MAA understands that many districts need additional funding, especially as they struggle with low reimbursements. For those who need to explore grants and other financial assistance, the National Association of Emergency Medical Technicians (NAEMT) provides a page dedicated to these opportunities.
A Value-Based Payment Model
As the trend of low reimbursement rates from insurance companies, Medicare, and Medicaid continues to plague EMS providers nationally and locally here in Missouri, these issues could lead to many of our districts adopting a value-based payment model in their billing. The term “value-based” refers to billing that is tied to the care provided to the patient. Instead of billing for services, districts would bill insurance companies for life-saving treatments, medication, and other procedures.
If the sector shifts towards this type of billing, reimbursement would be negotiated based on care. Yet, many districts may wonder how to put a price on our first-response care. Ultimately, EMS providers would structure billing similarly to how hospitals charge for services. For example, providing care for a diabetic emergency would include charges for insulin, supplies, and other related care and services.
The care, support, and response provided by EMS and ambulance services deserve fair compensation. Unfortunately, the current billing methodologies only allow for reimbursement for transportation to a hospital or medical facility, neglecting the care and support teams provided on the scene. When the patient does not require transport, the district/EMS provider fails to receive fair reimbursement for services rendered.
Policy Reforms at the State Level
State and federal policies can also impact reimbursement and billing for EMS providers. One of the most important roles that the Missouri Ambulance Association provides to all members is related to our lobbying efforts. The MAA retains a lobbyist to advocate for all EMS providers, working to make a positive impact with influential state representatives to support legislation that provides fair reimbursement for services and care rendered by medical first responders. Brent Hemphill and Associates serves as MAA’s lobbyist in Jefferson City.
New policies and legislation have the power to transform broken financial systems and level the power dynamic that exists in reimbursement negotiations between EMS providers and insurance companies.
The “No Surprises Act” Impact
The No Surprises Act was passed in 2020 and protects medical patients from receiving surprise charges on medical bills for services rendered from out-of-network providers at in-network facilities. These charges associated with out-of-network rates were typically unknown to the patient at the time of care. The Act also protects patients from out-of-network costs associated with air ambulance services.
There is a push to expand the No Surprises Act to EMS care, including ambulance transport. This expansion would limit how ambulance districts and EMS providers could bill patients they help who do not reside in their area (“out-of-network” or out of their jurisdiction). Expanding the Act could further perpetuate the financial pain experienced by many ambulance and EMS providers in Missouri who already struggle with low or nonexistent reimbursements.
Healthcare System and EMS District Partnerships
Some Missouri fire and EMS districts partner with local healthcare systems to provide transport and first-response care. These unique collaborative partnerships may allow the district to operate as an extension of the healthcare system partner and share the same reimbursement structure as the medical center or hospital. Looking ahead, these partnerships may be crucial to the financial security and stability of our ambulance districts and EMS providers.
Join MAA To Support Billing and Reimbursement Legislation
Missouri Ambulance Association provides training, support, and advocacy for EMS and ambulance districts across the state. Join MAA and help us advocate for change, fair reimbursement, and a more equitable billing structure to ensure that first responders can continue to serve the public through life-saving care, education, and emergency transport. Visit our site and social media pages regularly for the latest news and updates on the issues affecting Missouri’s EMS and ambulance providers.
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