Emergency Medical Services (EMS) revenue cycle management (RCM) is a multi-step process, beginning with agencies submitting patient documentation to their RCM partners or in-house staff who then code the charts according to ICD-10. Given the nature of EMS RCM—where there is no registration desk for the capture of patient insurance and demographics—having a team and tools focused on information gathering is crucial. After this data collection step, the claims are submitted, posted and adjudicated by the payer. If there remains a patient responsibility portion following payer adjudication, the patient billing cycle begins.
While some EMS agencies perform this process in-house, most prefer to outsource for purposes of convenience, consistency, efficiency and compliance. If you are currently looking to outsource your EMS RCM or are unsatisfied with your current partner, you may be wondering what steps to take to ensure you find the right partner for your agency that can help you reap the benefits of outsourcing. Most agencies opt to go through a request for proposal (RFP) process. In my experience here at Intermedix, I have read and responded to my fair share of RFPs for EMS RCM services. In doing so, I have identified key questions that you should ask if you care considering outsourcing.
- How many years has your company been in business?
- How many years has your company provided revenue cycle management (RCM) services for EMS?
- How many clients do you have and what type are they (for example: government, hospital, private)?
- What is the number of annual EMS patient encounters billed?
- Please list any professional EMS associations that your company regularly attends/supports/exhibits.
- Do you maintain Errors and Omissions Insurance coverage? If yes, what is the liability limit and who is the insurance company?
- How many offices do you have dedicated to providing EMS RCM services? Where are these offices located and how many dedicated EMS RCM employees are in each location?
- Please provide a brief description of your Business Continuity Plan/Disaster Recovery Plan.
- Please provide contact information, service start date, annual billed volume and annual deposits for the most recent calendar year for three current EMS clients of similar size, complexity, and scope.
Compliance / Regulatory
- Does your company have a Compliance Plan that is updated regularly?
- Is a copy of your Compliance Plan available for inspection upon request?
- In the past 10 years, has your company, its parent or a subsidiary ever been investigated for suspected fraud and abuse by any department or agency within the federal or state government such as OIG, Medicare, Medicaid, CMS or Recovery Audit Contractor?
- In the past 10 years, has your company, its parent or a subsidiary ever been required by a department or agency of the federal or any state government to follow a Corporate Integrity Agreement?
- In the past 10 years, has there been an investigation where the final determination resulted in a client paying a fine or penalty due to coding and billing actions that were related in any way to your provision of services?
- Please furnish evidence that all current employees are not excluded from participation in state and federal healthcare programs.
- Please provide a brief description of your company's quality or audit process.
- Is any auditing process provided by an external vendor or source? If yes, briefly describe these audits.
- What is your preferred method for receiving medical chart information?
- Are charts manually coded? If no, please describe the automated coding process.
- Please briefly describe the training process for a new coder that starts with your company.
- How are coding personnel audited? In your response, include the number of charts audited and the frequency of such personnel audits.
- If a coder fails to meet the defined acceptable percentage, describe the remediation process that is implemented.
- How are client charts assigned to coders? Are specific coders or groups of coders assigned to certain clients?
- Are all charts coded to one CPT or CMS standard, or are there payer-specific guidelines used?
- When coding the chart, if the coder determines there is not enough information to code the chart, what is the process for obtaining the necessary information?
- Please describe the circumstances in which a chart would be returned to a provider, and specify the time-frame providers are allotted to resolve documentation for a chart with incomplete or missing information.
- What is the typical length of time required to code a chart once the necessary information is received?
- Please describe your process, including the frequency, for providing documentation feedback to providers.
- Please provide a list or sample of any weekly or monthly client reports that are part of your standard client reporting process.
- How are requests for non-standard reports handled? Is there a cost for these types of reports? If so, how is pricing determined?
- Please include any additional information regarding your reports and the data tools provided to your clients.
- Is the EMS technology platform you use proprietary to your company or is it a third-party software?
- What level of access will be provided into the billing system? Will it include full visibility into all actions, notes, documents, etc.?
- How many IT staff are dedicated to supporting EMS technology solutions?
- How is clinical information stored, and for how long are these charts retained? If clinical charts are electronic, are these records retrievable by the client? Is there any additional cost incurred if a client wishes to access these electronic records?
- Is IT staff available to support the electronic data exchange of the electronic patient care report (ePCR)? Please describe the team responsible for this process and how the exchange works.
- Is IT staff available to support the electronic data exchange of patient demographics and charts with the hospital's IT department? Please describe the team responsible for this process and how the exchange works.
Implementation/Startup and Onboarding
- Will a dedicated project management team be assigned? Will weekly status meetings be conducted during the onboarding process?
- Does your company provide enrollment and credentialing support during the onboarding process? This includes Medicare & Medicaid enrollments as well as the prevention of certification lapses, and establishing all major payers on electronic claims and remits and EFTs throughout the duration of the partnership
- With which electronic patient care record (ePCR) vendors does your company have interface experience? Are they able to support NEMSIS 3 standards? How do you monitor ePCR trip import success and failures? How often is feedback provided?
- Do you provide feedback and advice on the quality of medic documentation? Can you assist in QA/QI audits to spot check problem areas?
I hope this list helps you get started in your endeavor to create or revise an RFP related to your organization’s EMS billing and coding process. As this list is not exhaustive and there are countless questions that could be asked, we’d love to hear any additional key RFP questions that you use. Let us know your supplementary questions in the Comment section below!