Did you know that your municipality could potentially gain additional Medicaid reimbursement if it can demonstrate that its allowed costs exceed amounts reimbursed?  More than 35 Massachusetts municipalities with public ambulance/EMS services have already collectively gained approximately $4.6 million in Medicaid reimbursements.

According to the Ambulance Certified Public Expenditure (CPE) Program, approved governmental ambulance providers can submit an annual cost report and receive additional payment if allowable costs for MassHealth services provided on or after April 1, 2013 exceed interim payments. The program is administered by the state’s Executive Office of Health and Human Services.

“Our first responders are doing their part to protect the state’s most vulnerable residents, and these resources provide the additional support to help more individuals in need,” Governor Charlie Baker said in an HHS press release

Lt. Governor Karyn Polito echoed his sentiments. “We are proud to offer this extra level of support to our ambulance and public EMS workers. We hope additional providers and communities will take the initiative to participate and bolster support for emergency services around the Commonwealth,” she said in the press release.

However, even despite the availability of these funds, New England Medical Billing (NEMB) has found that many municipalities struggle with the program. Some decide not to participate because they incorrectly assume that the task of cost reporting will be too burdensome. However, depending on the municipality’s volume of Medicaid patients, we’ve found that 2%-10% of additional revenue is possible, making it worth the extra effort to pursue. Municipalities receive these funds once annually at the time of cost reconciliation.

To report costs correctly, municipalities must separate the administrative costs of the fire department from those of the ambulance services. This can be difficult, given the fact that operational overlaps often occur. For example, many fire chiefs know that a paramedic could drive the fire truck or a firefighter could perform emergency medical services.

Following are two tips to help you get started with the CPE Program:

  1. Ensure compliant billing. Work with an outsource vendor that understands ambulance the nuances of ambulance coding and billing. This helps avoid overbilling, and it ensures accurate reporting relative to costs and payments. Compliant billing also mitigates the likelihood of a potential overpayment in which the municipality would be responsible for refunding the amount.
  1. Tag costs for EMS vs. the fire department. Track the following:
  • Direct service staff salaries (e.g., paramedics, EMTs)
  • Ambulatory services administration salaries (e.g., non-direct service staff)
  • Direct service support staff salaries (e.g., 911 call techs, QA techs, billing/account reps)
  • Benefits for direct service staff/administration staff/support staff, operating expenses (e.g., fuel, maintenance, repairs, plant operations, utilities)
  • Equipment depreciation
  • Equipment costs

To learn more about the CPE Program and how it can potentially yield greater reimbursement for your municipality, call Nancy Dolgin at NEMB at 508-297-2068 x232.

About NEMB

NEMB understands the importance of building meaningful relationships with entities and individuals within each municipality so we can ensure timely and compliant billing. Not only do we communicate regularly with fire and police departments, but we also take the time to get to know and network directly with town accountants, town managers, mayors, and others. We identify the key individuals within each municipality who can provide the critical information we need to bill ambulance services appropriately and as quickly as possible.

With nearly 10 years of experience in municipal ambulance billing, our credentialed staff members are trained in every aspect of effective municipal service billing. We specialize in auto accident claims that continue to challenge municipalities and result in significant revenue lost. We pursue auto accident claims as quickly as possible so our clients can take advantage of personal injury protection benefits before those benefits are depleted. Our expertise and focus on communication and relationship building help to maximize cash flow and ensure the fastest possible return on investment for the services provided. NEMB’s ambulance billing record has consistently yielded over a 90% collection rate.


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