Ambulance Billing Services

The Vendor is required to provide a professional billing firm to provide the City with submission of reimbursement claims services.
- The City operates both Advanced Life Support (ALS) and Basic Life Support (BLS) ambulances, handling calls for service of both 911 and Inter-facility origination.
- Current ambulance billing rates are published on the City’s website.
- Consultant will support the City in maximizing compliant revenue recovery, improving operational efficiency, and delivering high-quality customer service to patients and payors.
- Billing Services
• Proper patient care report (PCR) review, coding procedures, and coding compliance auditing.
• Audit of level of care coding practices.
• Review, coding, and submission of claims.
• Compliance with Medicare, Medicaid, and all applicable federal and state regulations.
• Electronic data interchange (EDI) processing.
• Insurance verification and eligibility checks.
• Denial management and appeals processing.
• Preparation and distribution of invoices in accordance with City-established rates and policies.
• Utilization of available resources to obtain billing and insurance information.
• Monthly billing reconciliation.
• Identification and reporting of errors (e.g., Not Medically Necessary, missing signatures, etc.) for correction and resubmission.
• Identification and explanation of refunds.
• Provision of software tools necessary to extract billing files from the City’s ImageTrend Elite Electronic Patient Care Reporting (ePCR) system.
• Provide annual training to City personnel on documentation improvement and billingrelated best practices, delivered either in person or in a format suitable for upload to the City’s Learning Management System (LMS).
- Collections & Customer Service
• Patient billing and follow-up activities.
• Limit of no more than three (3) collection attempts prior to returning accounts to the City.
• Customer service via phone, email, and online portal.
• Toll-free customer service availability, minimum Monday–Friday, 8:00 AM – 5:00 PM PST.
• Payment plan administration.
• Coordination with secondary payors.
• Function as the primary point of contact for billing-related customer service issues.
• Respond to City staff inquiries and requests within twenty-four (24) hours.
• Distribute customer service satisfaction surveys to at least fifty percent (50%) of billed patients at the time of invoicing.
- Reporting, Remittance and Analytics
• Transport volume and revenue.
• Incident number, date of transport, patient name, origin, destination, service level, mileage, and gross charges.
• Breakdown of transport volume, billed amounts, and collections (monthly and fiscal year-to-date), including Advanced Life Support (ALS) and Basic Life Support (BLS) units.
• Payor mix summaries (Medicare, Medicaid, insurance, private pay).
• Summary by Healthcare Common Procedure Coding System (HCPCS) codes.
• Total billed amounts, collections, refunds, adjustments, and outstanding receivables.
• Aging reports (30/60/90/120 days), including last activity and expected payment source.
• Denials and appeals tracking, including categorization by payor and reason.
• Accounts referred back to the City for collection or write-off.
• Uninsured accounts tracking.
• Ground Emergency Medical Transport (GEMT) program support and reporting.
• Customer service performance metrics (e.g., call volume, response times, etc.).
• Summary of customer satisfaction survey results provided to the City on a monthly basis.
- The Consultant shall provide real-time or near real-time dashboard access with key performance indicators (KPIs), including, but not limited to:
• Collection rates
• Days in accounts receivable (A/R)
• Denial rates
• Pay or mix.