Proper documentation of emergency transport determines reimbursement. Medicare or Medicaid imposes a reimbursement of your patient’s medical expense, but various healthcare providers offer different inclusions or services. Medical billing will apply codes for only those services documented. Not including necessary documentation can lead to underpayment.

What is the Process Involved?

To get to the hospital, your patients have to request an ambulance or another transport vehicle. Ambulances are a better option as they come equipped with all medical demands. In an emergency situation, paying ambulance bills or dealing with the ambulance staff asking if insurance allots them their charges is the least of their concerns. 

Insured compensation of ambulance transport is highly subjective, which means distinctive policies apply to different payers. Following a set protocol and set of questions arran is crucial. 

Sometimes, the ambulance claims depend solely on how grave the condition of the patient is and if the services provided were required. State laws and Medicaid also play an important role in this by justifying what counts as an emergency and what doesn’t. 

ET3 Payment Model for Better Reimbursement Possibilities

Insurance-related matters can be complex. The ET3 program announced in 2019 was intended to simplify the process. ET3 is also referred to as the Emergency Treat, Triage, and Transport model. 

Through ET3, the Central for Medicare and Medicaid Services (CMS) and the U.S Department of Health and Human Services (HHS) allow several compensatory beneficiaries to non-emergency payers to travel to places other than the emergency department.

ET3 is a 5-year payment structure that enables the ambulance team to act with compliance to address medical affairs. Under this ET3 scheme, the CMS will reimburse the payers to transport to a healthcare center, clinic, or community mental health care.

How Proper Documentation of Medical Necessity Determines the Payment of Ambulance Claims

Also, it also incorporates the facilitation of health care specialized faculty at the spot of the 911 scene or telehealth. This model gives local area some decision making authority over 911 and ensures the best quality and inexpensive treatments.

In addition, this structure awards cooperative agreements to finance and expand a triage line. Notice of funding opportunity (NOFO) and Public Service Answering Point (PSAP) assist in avoiding any unnecessary transportation and hospitalization. 

NOFO applicants are eligible for a PSAP region that provides transportation services, which meet the ET3 prerequisites. One can easily apply for a NOFO if they previously were an RFA ambulance supplier. Most importantly, any individual who requests 911 help and is covered with a medical triage line can participate in the model.

The ET3 RFA model has a 5-year performance plan, while an ET3 NOFO has a 2-year performance. The initiation of the ET3 model began in January 2021.

Responsible Documentation for Better Care

Incomplete and inconsistent document records will only lead to underpaid or non-compliant medical claims. Emergency responders must have the tools and procedures to gather the types of information that an ambulance transport took place or a medical transaction happened for maximum reimbursement to occur. In general, the following records are necessary:

  • Report of condition
  • Patient status on the scene of 911
  • All services used by the patient
  • A document with patients appearance and condition

Ensure that your Electronic Patient Care Reporting (EPCR) is setup to quickly and efficiently gather each element as well as relevant demographics and insurance information. To learn more about ambulance claims and medical billing, you can visit the NEMB Group.


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