Understanding Ground Ambulance Charges- Part II
Last week…
Welcome back to Part II of our series “Understanding Ground Ambulance Charges!
Last week we covered the basics. We defined the term charges and what it means and how it applies to the ground ambulance billing world. This week we focus on how charges are determined and by whom.
Strike the Myth
Because our role in this billing office is one of an outsourcing nature, we are often asked if we – the billing contractor – can simply set gross charges for our clients.
The answer is no. We cannot.
While we understand that our clients, especially our volunteer-based clients, see this as a value-added service provided by “the experts” in the business, there are just certain risks involved that prohibit us from making those determinations.
Each EMS agency is a separate entity. The ambulance providers and suppliers that we serve all operate in varied markets. The costs to provide the service differ. Local demographics differ.
In some States there are limits, one or two States, actually determine the charges an EMS agency can use when billing by setting those rates in a tariff system which must be approved at the State government level monitored by a regulatory agency. Even some localities have prohibitions that are set by municipal and county laws dictating what an EMS agency can or cannot charge.
So we’ll use this space to strike the myth that it’s the ambulance billing company’s responsibility to set gross charges for their client accounts.
Comparisons
What a billing office like ours can do is provide data to assist clients in making decisions about what to charge.
You can use comparison reviews based on what others are charging in the industry to help you make decisions using information regarding what other EMS agencies are doing (without divulging the individual agency identities, of course.) Reviews are useful when you can compare other agency charges by geographical region, size and scope of practice as those charges reflect the inherent costs other agencies like your’s is incurring as reflected in those fee schedules.
Our clients find it helpful to have this data at their fingertips.
Charges Reflect Cost
Of course, with reason, the charges you use typically will reflect the cost to do business.
When considering the Gross Charge fee schedule you will employ, consider using charges that reflect a fair approximation of the cost to provide the services you offer to your community when providing EMS services.
If your service is a non-profit or a municipal service, it’s likely you may need to explain the rationale for what you charge to the public. If your EMS agency is a for-profit, you’ll certainly be considering the competitive nature of how your agency’s charges stack-up against your nearest competitor while still insuring that you are not“deep discounting” your charges and thereby creating a compliance issue for your agency.
There reasonably should be some logical explainable reason(s) for determining your fee schedule. We know that our clients tell us they take into consideration the ethical considerations by being as fair as possible with the community they serve while still insuring an adequate cash flow to insure the sustainability of the service over the long haul.
A healthy bottom line equals a health EMS system.
Who Chooses and When?
Ultimately, then, who makes the final decision on what Gross Charges are put in play?
That depends.
Each EMS agency follows their leadership and decision-making process. We find that Boards of Directors, administrative leadership, elected officials…a varied number of decision-makers make the final decisions about the Gross Charges used in their fee schedules.
Whatever the case may be, it is a good idea for your EMS agency to periodically review charges to insure that you are keeping up with the changes in the costs to provide the service and what the overall market is dictating as a whole.
Your EMS agency’s Gross Charge fee schedule drives revenue which funnels reimbursement dollars to you so you can operate in your EMS system. Failing to stay on top of this important factor, will stagnate your EMS billing program and potentially hamper your ability to drive adequate funding back to your agency.
