Ground EMS Billing Services

The vendor required to provide ground emergency medical services (EMS) billing and revenue cycle management services for all EMS transports performed by the department.
- All services must be delivered through a secure, fully paperless process and must cover the complete billing lifecycle from claim creation through final account resolution.
- Requirement:
1. Claim preparation and coding
•    Intake and validation of all trip documentation, including ePCRs, pcs forms, run sheets, patient demographics, signatures, and insurance information 
•    Insurance eligibility verification and identification of primary, secondary, and tertiary coverage as applicable 
•    Accurate charge captures and claim construction 
•    Coding support and compliance with all applicable billing, diagnosis, and procedure coding standards 
•    Claim scrubbing and edits before submission to minimize rejections and denials 
•    Identification and resolution of missing or incomplete documentation before billing
2. Claims submission and processing
•    Submission of electronic and paper claims as required
•    Compliance with all timely filing requirements
•    Clearinghouse rejection monitoring and correction
•    Claim status tracking and payer follow-up based on defined aging standards
•    Management of payer requests for additional documentation
•    Coordination with the city to resolve documentation gaps and claim issues
3. Denial and appeal management (including NSA/IDR)
•    Denial prevention and root-cause tracking with corrective action feedback
•    Categorization, prioritization, and resolution workflows for all denial types
•    Timely submission of appeals with required supporting documentation
•    Identification and recovery of underpayments
•    Payer dispute follow-up through final resolution
4. Payment posting and reconciliation
•    Electronic remittance advice (era) and manual payment posting
•    Posting and categorization of contractual adjustments and payer actions
•    Deposit reconciliation against posting activity
•    Identification of offsets, recoupments, take-backs, and posting errors
•    Refund coordination and resolution of credit balances
5. Customer service
•    Toll-free customer service support line with defined hours
•    Assistance with patient inquiries, statements, and payment plan administration (if offered)
•    Payer phone follow-up support
•    Processing of correspondence and documentation of all call notes
•    Escalation path for complex or sensitive accounts
6. Compliance and reporting
•    HIPAA compliance and phi security safeguards
•    Audit readiness support and documentation retrieval
•    Standard monthly and ad hoc reports, including:
o    Charges, payments, adjustments, and net collections
o    Accounts receivable aging and days in A/R
o    Clean claim and rejection rates
o    Denial, appeal, and overturn rates
o    Patient balance and collection performance
o    No surprises act (NSA) and independent dispute resolution (IDR) activity and outcome reporting (if applicable)
7. Collections
•    Issuance of patient billing statements and follow-up cycles
•    Payment plan administration (if offered)
•    Processing of financial hardship requests as allowed by city policy
•    Identification of accounts for potential bad-debt placement and recommendations to the city
•    Compliance with all applicable state and federal collection requirements
8. Implementation and transition support
•    Implementation timeline and milestones
•    System setup and payer connectivity support
•    Data onboarding and secure data exchange processes
•    Transition of open claims and existing accounts receivable
•    Go-live stabilization plan.