How revenue cycle technology can rescue EMS payments

Revenue cycle management for emergency medical services (EMS) providers can be summed up in one word: retroactive.

Unlike the majority of traditional healthcare services in which patient insurance information and financial obligations are properly vetted early in the care cycle, ambulance providers perform most revenue cycle steps retrospectively, and for good reason.

Many EMS transports are emergency and trauma scenarios—where the patient is unconscious or not physically able to provide demographic or insurance information. This presents unique challenges for EMS providers because of a lack of revenue cycle resources, such as checking with the patient or family members for additional information. After the transport is complete, EMS staff can’t easily visit the patient’s room to obtain demographic or insurance details, as is common practice in acute care hospitals and health systems.

Another hindrance to effective revenue cycle management for ambulance providers is technology integration—for three reasons:

• Current EMS software solutions lack the ability to seamlessly facilitate payer-provider interactions.
• Secure access to acute care and physician practice EHRs remains elusive in many communities.
• The absence of capital resources and IT knowledge to implement revenue cycle tools is a very common scenario for EMS providers.

While the technology end game for EMS providers is the same as for other healthcare organizations—mitigate revenue risk and maximize return on investment—the unique challenges they face render a different approach to revenue cycle automation. This article explains how one EMS organization, Regional Emergency Management System Authority (REMSA), in Reno, Nev., paved a successful path to stronger patient collections and revenue recognition using an integrated, best-of-breed IT approach.

According to Chris Watanabe, vice presidents of business services and HIPAA Officer at REMSA, “The sharp rise in self-pay patients cycling through the healthcare system presents a plethora of revenue cycle challenges for all healthcare providers—especially EMS.” Even though Nevada was a Medicaid expansion state, Watanabe still saw large volumes of self-pay patients and needed to track them as closely as possible.

With 45,000 trips annually and a 5 percent to 6 percent growth rate year over year, REMSA sought to automate processes within their business office and revenue cycle teams. Watanabe immediately went to work securing best-of-breed technology and service solutions to accomplish three key goals:

• Capture accurate patient demographics sooner in the revenue cycle.
• Discover more billable insurance coverage to reduce collection costs.
• Eliminate printing of patient statements and invoices.

REMSA’s revenue cycle management staff are the lifeline to financial health and sustainability. “They were directly involved with reviewing software purchases and are consistently solicited for new ideas on how to improve workflow and processes,” says Watanabe. “Automating portions of our revenue cycle to search and discover commercial coverage for more patients has improved staff efficiency, and in most cases does not result in employee layoffs, but rather a reallocation of resources.” Automation is as much about the people and processes that surround the technology as it is about the technology itself.

Although the trend in EMS is to automate a larger portion of revenue cycle processes, potential efficiencies simply can’t be realized unless core competencies are intact. In other words, the first step in automating revenue cycle management is to ensure the rest of the house is running efficiently. Providers should ask three questions before evaluating technology and service vendors. These represent examples of important in-house functions that must be secured before implementing revenue cycle automation tools:

• Are there competent coders and billers on staff?
• Are all staff properly trained on correct patient account and collection follow-up protocols?
• Is someone assigned to understand the legalities of denials and appeals management?

Watanabe’s implementation strategy focused on automating front-end EMS revenue cycle management functions through a comprehensive upgrade to their Zoll EMS system and two new revenue cycle technology partners: ZirMed and Payor Logic. The three best-of-breed vendors worked together to achieve measurable results for REMSA.

After 24 months, Watanabe effectively found more billable commercial coverage for REMSA’s self-pay patients, reduced collections costs and increased cash flow. In fact, according to Watanabe, “REMSA realized an 18 percent reduction in cases sent to their third-party collections agency through stronger revenue cycle automation.”

Breaking down some of the most important elements to realize when implementing these automation solutions, she offers this advice for other EMS providers:

• Stay in tune with IT departments and their capacities—don’t be afraid to use them but be crystal clear on their involvement.
• Use technology vendors as partners—leverage their knowledge, references and contacts more effectively.
• Develop a bird’s-eye view of all upstream and downstream processes—what effect the implementation of a new tool will have.
• Don’t beat yourself up over failures—go forward, learn from mistakes and move on without repeating them.
• Understand that with technology change comes social change and never discount the human capacity—ability, qualifications, aptitude—for change.
• Practice patience and celebrate small victories—an important motivator in the context of larger, more time-consuming changes.

Paving a path to EMS revenue cycle management automation should always begin with an understanding and acceptance of the unique nuances in pre-acute care. Improving cash flow and reducing administrative burden through technology is a universal goal in healthcare, but the EMS sector is notably behind other providers. Conducting an internal audit of EMS processes, people and workflow before implementing any solutions is imperative.