Facts

• Background

  In the mid-1960s, EMS providers underwent a significant transformation in their mission to deliver patient care in the field. The concept of pre-hospital care expanded to encompass a comprehensive program involving first responders, basic life support (BLS) and ALS transporting units, ALS fly cars, and air ambulances. With the rapid growth of these services, non-commercial EMS providers and rescue services faced a persistent challenge: lack of funding.

  However, there is promising news—over 90% of patients transported by EMS are covered by insurance plans or entitlements. The 2012 Affordable Health Care Act (AHC) further strengthened this coverage by including ambulance services within acceptable insurance plans. Additionally, current proposals to modify the AHC contain language that covers emergency transportation to the hospital. As a result, volunteer and municipal EMS providers are entitled to recover funds through insurance billing.

• Rediscovering Traditional Approaches

  Revenue recovery for EMS is not a novel concept. In fact, commercial EMS providers have been implementing billing practices for years. Interestingly, most states do not distinguish between volunteer or municipal EMS providers and commercial EMS providers. This presents an opportunity for any EMS provider with the appropriate license and certification to bill for their services as long as they continue to adhere to all State and Federal standards.

• Rescue Revenue Recovery

  Rescue revenue recovery is another concept we have introduced on the East Coast. Incidents like auto accidents, hazardous materials spills, and industrial mishaps often necessitate more manpower and specialized equipment than standard ambulance transports. While such services are typically covered by insurance, there are additional costs linked to rescue calls that may go unrecovered by the provider.

  Failing to recoup these expenses from insurance companies could result in the community shouldering the financial burden. It is imperative for EMS providers to pursue the full recovery of all funds resulting from these critical rescue operations.