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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 (PCG) can show you how.

 

This proposed “supplemental payment program” requires no additional spending by the state Medicaid agency beyond what it pays providers now. PCG assists the Medicaid agency in establishing a CMS approved methodology to claim existing expenditures in a way that provides additional reimbursement from the federal government.

The PCG Approach – Helping Medicaid Agencies and EMS Providers

Experienced PCG professionals will work with ambulance associations, EMS providers, and your state Medicaid agency to develop a supplemental payment program that yields additional revenue. Steps may include

  • Providing best-practices solutions to design the most appropriate supplemental payment program to address a state’s unique requirements.
  • Assisting with gaining federal approval of the program.
  • Conducting cost benefit analysis pertaining to implementation of a supplemental payment program.
  • Leading implementation of the program for the state/local EMS agency.
  • Facilitating provider outreach and encouraging participation in the program.
  • Developing policies and procedures manuals and providing training state officials and EMS agencies.
  • Reviewing financials associated with the delivery of emergency medical services.
  • Preparing and submitting cost reports essential for receiving reimbursement.

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.

PCG Expertise

Our firm has 30 years of experience with revenue enhancement projects for state and local government agencies and public and private medical service providers across the U.S. PCG will apply our proven approach, deep program knowledge, and experienced team to design and implement an EMS supplemental payment program that leverages existing EMS expenditures to maximize Medicaid revenue related to the delivery of emergency medical services.

 

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

State of Texas Health & Human Services Commission

Designed and developed the ambulance supplemental payment program and have worked with the state’s largest providers, including Austin – Travis County EMS, Dallas Fire-Rescue, Houston Fire Department, and San Antonio Fire Department to implement the program.

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.

State of Texas

State of Texas

From FY11-FY15, PCG helped 11 providers capture an additional $130 Million in supplemental payments.

Massachusetts

Massachusetts

FY13-FY15: 50 providers participated in the program. $12 Million in funding was captured statewide.

An Option for Private Providers

While a supplemental payment program approach is only available to public (governmental) providers, federal regulations offer a second option that can generate additional Medicaid revenues for public and private providers. A “provider assessment” utilizes funds raised through an assessment on the state’s providers to draw down additional federal matching funds, passing this additional revenue back to providers in the form of rate increases.

 

Few firms have PCG’s level of experience and expertise in assisting states to implement provider assessments; our background in this arena is extensive. We have worked with a number of states to develop provider assessment models, assisting to shape payment policy and ensuring positive outcomes for providers. PCG can assess the viability of the supplemental payment program and provider assessment options to find an approach that works for you.

 

 

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Download the Emergency Medical Services (EMS) Medicaid Supplemental Reimbursement Programs Datasheet

If you would like a printable copy of this information please download our datasheet.

 

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More Information

For more information about PCG Health's Emergency Medical Services (EMS) Medicaid Supplemental Reimbursement Programs please contact us at info@publicconsultinggroup.com or 1-800-210-6113.