EMS REVENUE GENERATION
Increased profitability is every private ambulance company’s goal. To achieve profit targets, organizations must control key factors that contribute to lost or delayed revenue. It is vital to understanding your performance against key indicators including: LAG, Denial Management, Facility Run Data, Fee Schedules, Call Intake and Insurance Payer Mix. Having the proper processes and procedures in place ensures higher revenue and profits. AAG’s Process Practice Managers (PPM’s) will help you develop the right structure to drive greater efficiencies while maximizing your profits.
Facility Run Data
This is the classic Quantity vs. Quality. As an EMS provider, you need to know if the facilities you're servicing are profitable for you. AAG helps you understand the cost per facility and net profits based on each run type (ALS, BLS, CCT, WC, etc). With this data you'll understand all your production numbers by facility. It is sometimes surprising to learn that facilities or cost centers that are generating high amounts of revenue might actually be generating little to no profit. When you combine run volumes, revenue, costs, payer mix and net earnings it gives you the information to make critical decisions.
Billing Lag
When billing delays exist, the entire accounts receivables process suffers and drains your organization of the necessary resources to collect all the reimbursement due to you. To ensure timely billing, you need a comprehensive process for gathering data, verifying compliance and confirming that no trips are missed. With a correct process and a properly deployed billing system, you can have charges entered and billed within days rather than weeks.
Denial Management
With rising healthcare complexity and pre-authorizations, claims are often being denied or delayed and there is increasing scrutiny of claims from government and commercial payers. The best way to reduce denials is to catch and fix billing mistakes before a claim is ever generated. For claims that are denied, you need a systematic and measurable process to appeal unpaid claims. So many organizations fail at this vital business process and leave a significant portion of revenue uncollected. To reduce denials and identify the causes of your denials, AAG recommends advanced analytics and machine learning tools to keep you on track. AAG will determine the right steps to stop the revenue leak and keep you ahead of the game.
Fee Schedules
Ambulance organizations need a clear understanding of their fee schedules with government payers, private insurance payers and facility contracts. With modern collections and payment analytics systems, you can monitor your payments and confirm you are being paid at the appropriate level.
Payer Mix
Call Intake
While it is important to understand your overall payer mix, it is even more important to understand how the payer mix at your various pickup locations affects your payment. With proper analytic profiling, you’ll be alerted when you routinely get a higher percentage of denials or payment issues from certain pickup locations. When you combine payment, costs and payer mix, it creates a Profit and Loss profile for each pickup location. Armed with this information, you can better manage and control your schedules trips.
Dispatch is where it all starts. The intake process needs to be optimized to avoid billing delays and to stay ahead of denied claims and returned statements.