Cost Recovery Program for Emergency Medical Services (EMS)

Medicaid payment rates for ambulance services are often 70 percent less than the cost of providing those services. With state budgets under significant pressure, the prospects for addressing this inequity with traditional measures are dim. However, there is another option. State Medicaid agencies and the Emergency Medical Services (EMS) community can work together to cover the shortfall by taking advantage of a unique reimbursement mechanism offered by the federal government.

Public Consulting Group can show you how:


The PCG Approach

Benefits

Expertise

EMS Projects

 

This proposed EMS cost recovery Program requires no additional spending by the state Medicaid agency beyond what it pays providers now. PCG works on behalf of EMS providers to accurately identify all allowable revenue sources, ensure compliance, and prepare annual cost reports.

The PCG Approach – Helping Medicaid Agencies and EMS Providers

Using our web-based cost reporting system, our team will work with you to:

Determine Medicaid allowable costs

Identify reimbursable claims

Prepare an audit trail

Assist with maintaining compliance

Facilitate trainings and ongoing support

 

PCG’s web-based cost reporting system can be customized to meet a state’s unique EMS cost reporting requirements. Our system integrates the federally-approved cost reporting template into an easy-to-use online application. The system streamlines data input and calculations and implements numerous real-time validation checks for quality assurance and accuracy. The cost reporting system handles all calculations related to the determination of allowable costs and cost settlement, and it allows providers to easily create financial and billing reports to view year-to-year trend analysis.

 

Benefits


With a well-designed EMS supplemental payment program, agencies will see that the gap between the cost of providing services to Medicaid recipients and what Medicaid pays for those services can be significantly reduced. A sound supplemental payment program will increase Medicaid reimbursement for states and the providers that partner with them. These incremental revenues can be realized with limited cost to the state and EMS providers. PCG’s consultants and cost reporting professionals have the experience and expertise to assume the administrative burden throughout all phases of the design, development, and implementation of a supplemental payment program. Let the PCG team work for you.

Expertise


PCG has more than 30 years of experience developing, implementing, and administering EMS revenue enhancement programs. PCG will apply our proven approach, deep program knowledge, and team experience to design and/or implement an EMS cost recovery program for your state that leverages existing EMS expenditures to maximize Medicaid revenue related to the delivery of emergency medical services. Once a program is designed and implemented in your state, we can also work with you at a state and/or provider level to develop online tools, define processes, stay compliant, and maximize your reimbursement.

 

Ask us about our successful EMS revenue maximization projects, including the following:

EMS Projects

State Level Program Design



State of Texas Health & Human Services Commission

Designed and developed the ambulance supplemental payment program and have worked with the state Health and Human Services Commission and the provider community to implement and operate the program for last eight years.


Massachusetts Executive Office of Health & Human Services

Developed a state-wide Certified Public Expenditure (CPE) program that provides additional Medicaid reimbursement to ambulance providers through a cost settlement process. Designed and implemented a web-based platform to expedite cost reporting, providing program oversight to more than 70 EMS providers across the Commonwealth.


Provider Program Implementation



Florida Public Emergency Medical Transport Providers

In FY16, PCG provided Cost Recovery services for over 30 participating Public Emergency Medical Transport (PEMT) program providers.


Texas Ambulance Supplemental Payment Program (ASPP)

From FY11-FY16, PCG helped more than 25 providers participating in the Ambulance Supplemental Payment Program (ASPP).


 

Florida

  • Provided Cost Recovery services to more than 30 Public Emergency Medical Transport providers, which are projected to generate $15 Million in incremental Medicaid supplemental payments.

     

     

 

Texas

  • Designed the ambulance supplemental payment program for the Texas Health & Human Services Commission. From FY11-FY16, PCG helped more than 25 providers capture over $175 million in supplemental payments.

     

 

Massachusetts

  • Developed state-wide Certified Public Expenditure (CPE) program for the Massachusetts Executive Office of Health and Human Services that captured an additional $21 Million in funding for the 62 participating providers from FY13-FY16.

About Public Consulting Group

Public Consulting Group, Inc. (PCG) is leading public sector management consulting and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has nearly 2,000 professionals in more than 60 offices around the US, in Canada and in Europe. PCG’s Health practice offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes. To learn more, visit http://www.publicconsultinggroup.com/health.

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