EMS Billing Services

The Vendor is required to provide EMS transport system, and the city’s EMS billing program is essential to sustaining that service through timely, accurate reimbursement.
- Requirement: 1. Billing operations and revenue cycle management
• EMS billing and revenue cycle services for treatment and transport accounts.
• Services shall include charge capture, coding, claim creation and submission, payment posting, adjustments, follow-up, and account resolution.
• Billing operations shall be designed to maximize appropriate reimbursement while maintaining compliance with payer requirements and applicable laws.
• Timely billing workflows, document all account activity, and promptly identify documentation issues that may affect reimbursement.
• Coordinate with department to correct documentation gaps when needed.
2. Electronic claim submission and clearinghouse services
• Electronic EMS claims through an approved clearinghouse or direct payer connection in the format required by each payer.
• Primary and secondary billing, coordination of benefits, claim status monitoring, payer follow-up, and resubmissions as needed.
• Maintain all required payer and clearinghouse connections to ensure continuous claim flow and provide visibility into claim submission, acceptance, rejection, and adjudication status.
3. Claim scrubbing and pre-submission validation
• Review and validate claims before submission to identify missing information, coding issues, modifier errors, eligibility or coverage conflicts, payer requirements, and needed attachments.
• Correct errors within its control and clearly identify any items requiring department input, including specific guidance for resolution.
• Use pre-submission edits to reduce rejections and denials, improve first-pass claim acceptance, and maintain updated edit rules based on payer and regulatory changes.
4. Denial management and appeals support
• Actively manage claim rejections and denials, including issue review, root cause tracking, corrective action, and timely resubmission.
• Support appeals, reconsiderations, and rebuttals when appropriate, including preparation of required documentation or written justification.
• Denial activity shall be tracked by payer, denial reason, crew/unit, and documentation issue type.
• Recommendations to reduce repeat denials and improve collections over time.
5. Payer enrollment and connectivity
• Support payer enrollment, credentialing as needed, and electronic connectivity with Medicare, Medicaid, and commercial payers for claim submission and remittance processing.
• Maintain payer tables, city-approved fee schedules, and payer-specific billing rules.
• Promptly address connectivity issues, trading partner changes, and payer policy updates, and ensure electronic remittance and eligibility tools remain accurate and functional.
6. Customer service and patient/payer liaison
• Professional customer service for patients, family members, insurers, attorneys, and other payers regarding EMS billing and account questions.
• Assign a liaison for city escalations and ensure timely response and resolution of concerns.
• Customer service shall include clear explanations of charges, insurance coverage, patient responsibility, disputes, and documentation requests while maintaining HIPAA compliance.
• Patients and attorneys upon request - patient records and documentation with proper authorization, including billed, unbilled, transported, and non-transported incidents.
• All customer service interactions shall be logged, available for city review, and reported through measurable service levels such as response times and call handling metrics.
7. EPCR/EHR reporting system
• The city currently utilizes an established EPCR/EHR reporting system that is extensively integrated with its public safety, records management, billing, and other operational systems.
• Due to the complexity and critical nature of these integrations, the city does not intend to replace its existing EPCR/EHR reporting system as part of this solicitation.
• EMS billing solution shall be fully compatible with the city's existing EPCR/EHR system and support all necessary interfaces and data exchanges required to perform the services.
• Any recommended enhancements or integration improvements may be included in the proposal for the city's consideration; however, such recommendations shall not require replacement of the city's existing EPCR/EHR system.
8. Customer service and patient support
• Respondent shall answer all patient and insurance questions by phone or mail, using local or toll-free phone numbers, and act as the main contact for billing concerns and patient care/billing records requests from patients and attorneys with proper authorization documentation.