Emergency Medical Services Billing, Claims Processing, and Revenue Cycle Management Services

The Vendor is required to provide comprehensive emergency medical services (EMS) billing, analytics, and collection coordination services for the city department.
- Shall implement industry best practices to maximize lawful reimbursement, minimize billing delays, and actively manage accounts receivable through ongoing monitoring, follow-up, and resolution.
- Provide robust analytics, reporting, and performance insights to support data driven decision-making, financial transparency, and continuous improvement of EMS billing operations.
- Provides comprehensive emergency services, including fire suppression, Basic Life Support (BLS), and Advanced Life Support (ALS) ambulance transport.
- The City seeks a qualified and responsive billing firm to:
• Maximize reimbursement across payer types.
• Ensure regulatory compliance with HIPAA, CMS, and state-specific billing rules.
• Provide detailed analytics and revenue cycle reporting; and
• Support excellent patient-facing customer service.
- Provide full-service EMS billing, analytics, and collection coordination on behalf of the district.
- Responsible for the timely, accurate, and fully compliant processing of EMS transport claims, including billing to Medicare, Medicaid, commercial insurers, and self-pay accounts. In addition to core billing functions, the Contractor must provide high-quality analytics, revenue cycle reporting, and strong customer service that reflects the City’s patient-focused values.
- Objectives:
• Maximize lawful collections across payer categories
• Ensure regulatory compliance with all applicable federal and state laws, including CMS and HIPAA
• Provide strategic value through robust analytics and financial reporting; and
• Support smooth service operations through professional, respectful, and accessible customer service
- Claim Preparation and Submission
• Accurately prepare and submit claims to Medicare, Medicaid, commercial insurers, self-pay accounts, and other agencies.
• Assign appropriate medical billing and procedure codes and validate claim completeness, documentation sufficiency, and payer-specific requirements prior to claim submission.
• Identify, communicate, and assist in resolving missing, incomplete, inaccurate, or deficient documentation issues in a timely manner to minimize billing delays and claim denials.
• Submit claims in accordance with applicable payer filing deadlines, CMS requirements, regulatory standards, and industry best practices.
• Maintain processes designed to support timely claim submission, minimize claim rejection and denial rates, and reduce accounts receivable aging.
- Payment Processing and Reconciliation
• Monitor payment activity and proactively follow up on denials, underpayments, unpaid claims, rejected claims, and aging accounts receivable.
• Reconcile electronic funds transfers (EFTS), remittance advice, payment postings, and related payment processing activity with internal billing records and claim adjudication data.
• Accurately document all payment activity, adjustments, write-offs, refunds, credits, reversals, and account actions within the billing system.
• Identify and investigate payment discrepancies, unapplied payments, duplicate payments, and reconciliation variances and resolve such issues in a timely manner.
• Provide reconciliation reports supporting daily deposits, payment posting activity, adjustments, refunds, and aged accounts receivable balances.
• Perform denial trend analysis, root cause identification, and reimbursement analysis to support corrective actions, documentation improvement, payer compliance, and revenue optimization.
• Maintain audit-ready financial and transaction records sufficient to support city review, payer audits, dispute resolution, and regulatory compliance activities.
- Patient Billing and Account Follow-up
• Generate and distribute accurate patient statements in accordance with industry best practices.
• The new firm will be required to mail notice of privacy practices to both transported and non-transported patients (i.e., refusals) when the form was not provided to the patient by department staff.
• Provide payment plan options for qualifying patients and follow up on outstanding balances.
• Any proposed early-out or collection-related services shall be subject to city review and approval and shall not replace the cities designated third-party collection agency unless expressly authorized in writing by the city.
• Reclassify accounts by revenue source after payment is received (e.g., primary to secondary payer, private pay to Medicaid).
• Maintain detailed records of collections, including patient correspondence and payer responses.
- Coordination with City-Designated Debt Collection Agency
• Perform reasonable and customary collection efforts, account follow-up, patient communications, payment coordination, and denial resolution activities prior to referral of delinquent accounts to the third-party collection agency.
• Coordinate transfer of unresolved delinquent accounts to the City’s designated collection agency, including transmission of required account documentation, billing history, and supporting records necessary for collection activities.
• The Contractor shall not refer accounts to any alternate collection agency.
• Cooperate with the City and its designated collection agency to support continuity of operations, account reconciliation, dispute resolution, account recalls, and compliance with applicable laws and regulations.
- Customer Service
• Its customer service model for handling patient billing inquiries, disputes, payment coordination, complaints, and account-related communications.
• The training, qualifications, supervision, and quality assurance practices utilized for customer service personnel, including training related to EMS billing protocols, applicable privacy laws, and escalation handling.
• Available patient support methods for individuals with and without digital access, including telephone, mail based, online, and self-service support options.
• Available multilingual services, ADA-accessible communication methods, and accommodations for elderly, disabled, vulnerable, or technologically limited patients.
• Shall identify the number of customer service representatives assigned to the City, including staffing availability, business hours, supervisory structure, response time targets, and escalation procedures.
• Shall identify average call response times, abandoned call rates, escalation response times, and procedures for monitoring patient satisfaction and complaint resolution.
• Shall describe the location, staffing model, and operational structure of customer service and call center operations, including whether services are domestic, offshore, nearshore, or hybrid.
- Documentation Retention
• Maintain all EMS billing records, including accounts receivable, adjustments, balances, and collections, in accordance with all applicable federal and state retention requirements, including HIPAA, Medicare, and Medicaid regulations.
• Ensure the City has timely access to all records upon request, including following expiration or termination of the Contract, for audit, legal, or operational purposes.
• Maintain and manage EMS billing records, data and documentation. The Contractor shall review and respond to records requests in a timely manner and release records in compliance with all applicable HIPAA and privacy regulations.