Other payment option
Payment by facility
Emergency interfacility transfer
Non-emergency interfacility transfer
800 1,200 1,600 2,000 2,400 2,800
Monitor Vehicles | Manage Driver Behavior | Fraudulent Claim Protection
PAYER GROUPS BY RUN TYPE
The final measure considered was payer
groups by run type. Our primary operations are divided into two distinct divisions,
9-1-1 and non-emergency transports (NET).
Within those divisions are unique run types
that can have a different type of payer associated. (See Figure 2.)
As expected, the 9-1-1 division accounts
for the majority of the documented self pay
encounters, while the NET division almost
always has some form of funded payer docu-
mented to it. Another area to take note of is
the ratio of Medicaid encounters in compar-
ison to Medicare or other commercial insur-
ance, since Medicaid traditionally pays lower.
Specifically, we looked to see if the no payer
issue was related to one division over the other.
As expected, the number of no payers encountered was higher among 9-1-1 responses.
Further analysis revealed that the individual
provider had more impact on this than the
physical location of the patient.
After reviewing the data, conducting audits
of random PCRs and consulting with several
of the long-term supervisors, it became clear
that the majority of the no payer documen-
tation was a result of conflicting information.
This led to increased costs associated with
labor in research, delays in payments and lost
revenue for the claims in which no information
could be recovered due to an incorrect medical
record number or misspelled patient name.
Other risks that could impact a service
include lost revenue through missed filing dead-
lines, increases in billing charges associated
with outsourced vendors and the need to hire
additional personnel for in-house billing teams.
The most optimal time to obtain this
information is prior to the EMS crew leaving
The first step in overcoming this issue was educating the entire agency on the importance of
collecting insurance information. The second
step was walking through ePCRs. This allowed
us to identify the fields associated with insurance information and explain what they are, how
Figure 2: Payer groups by run type for incidents in FY 2017
Galveston EMS primary operations are divided into two distinct divisions, 9-1-1 and non-emergency transports. Each division has unique run types which can have a different type of payer.