We provide a full array of revenue optimization, supplemental payment program, cost reporting, and cost allocation services to local and state governments, fire departments, and ambulance service providers. PCG helps providers optimize revenue, maximize reimbursement, and maintain compliance. We offer services ranging from cost report preparation and audit support to statewide program administration.
PCG has 36 years of experience and over 550 providers generating over $600 million for clients across the country through Medicaid cost recovery programs.
Cost Recovery Programs for EMS Providers
Medicaid payment rates for ambulance services are often 70 percent less than the cost of providing them. 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 EMS community can work together to cover the shortfall by taking advantage of a unique reimbursement mechanism offered by the federal government - Supplemental Payment Programs (also known as GEMT, PEMT, and ASPP).
What Our Clients Are Saying
“As a metro fire district, maximizing revenue streams is important for long-term sustainability. We relied on PCG's expertise to analyze our true costs of transporting Medicaid patients to prepare us for the development of our cost report. This allowed us to gain a significant new revenue source so we can concentrate on delivering the very best emergency medical services to the community we serve.”
– Jeremy Metz, Division Chief of EMS, West Metro Fire Protection District
“We really found an excellent source of untapped revenue through the CO EMS Supplemental Payment program. The initial application was very detailed and using PCG to produce an initial data study was well worth it to make sure we didn’t miss any details and would receive the highest reimbursement possible.”
– Gordie Olson, Fire Chief, Thornton Fire Department
State Level Program Support Services
Supplemental Payment Program Initiation
We work with key stakeholders to establish legal/operational grounds to design and implement a supplemental payment program that best aligns with the needs of the provider community.
Supplemental Payment Program Expansion
PCG will assess your agency to optimize supplemental payment revenue, streamline and automate with a web-based cost reporting tool, and create an audit trail.
Managed Care Program Implementation
We will develop a framework to incorporate Medicaid managed care into currently operational Fee for Service GEMT/ PEMT programs.
Strategy for Private Providers
We will establish an integrated or separate program model to increase reimbursement levels for the private provider community with your state.
EMS Provider Support Services
Complete Cost Reports
PCG will reduce your administrative burden by managing the cost reporting process from start to finish. We will identify reporting requirements, collect and analyze your data, and identify opportunities for revenue maximization.
Prepare an Audit Trail
As part of the cost reporting process, we will store your supporting documentation on our web-based tool, keep track of data decisions, and provide desk review and audit support.
PCG’s team conducts multiple rounds of quality assurance to maintain compliance with state and federal policies.
Managed Care Program Operation
PCG will design and maintain a Medicaid managed care payment model utilizing encounter and claim data to establish and monitor the transfer of funding to qualifying EMS providers.
A dedicated Cost Reporting Lead assigned to you will provide project management and ongoing support to meet deadlines, maintain program compliance and provide an efficient cost reporting experience.
Our team of experts will provide trainings on cost reporting tools, policies, and new requirements, keeping you up to date on state and federal regulations.
Our Approach: Web-Based Cost Reporting System
PCG’s web-based cost reporting system integrates the federally approved cost report template into an easy-to-use online application. This tool can be customized to meet a state’s unique EMS cost reporting requirements. The cost reporting system also 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.
Using our extensive experience and web-based solution, our team will work with you to:
Create an audit trail
Supplemental Payment Program Expansion
PCG will assess your agency to optimize supplemental payment opportunities, alleviate the administrative burden, and create an audit trail for compliance. We will utilize our proprietary web-based cost reporting tool to streamline and automate the process.
EMS Cost Recovery Programs
Illinois Ground Emergency Medical Transportation
Assisted 16 EMS providers since 2019, the first year of the program, and generated over $18.5 million of additional revenue.
Florida Ground Emergency Medical Transportation
Provided cost recovery services to over 62 EMS providers, generating
$190 million in incremental Medicaid revenue since 2016.
Oregon Ground Emergency Medical Transportation
Since 2019, assisted 19 EMS providers in the State of Oregon, generating $6.8 million of additional revenue for these providers.
Iowa Ground Emergency Medical Transportation
Provided cost reporting, policy, and audit compliance to 32 EMS providers since 2019 and generated $8.6 million.
Massachusetts Public Ambulance Certified Public Expenditure (CPE)
Developed the CPE program, generating over $100 million in additional funding for nearly 107 EMS agencies from 2014 to 2021.
Missouri Ground Emergency Medical Transportation
Completed and submitted cost reports for 25 EMS providers in 2018 and 2019, generating over $7.8 million in additional funding.
Colorado EMS Supplemental Payment Program
Developed a statewide program in 2018, generating over $105 million in additional funding for 84 EMS agencies from 2018 to 2020.
Texas Ambulance Services Supplemental Payment Program
Designed the first program that helped to capture over $678 million in supplemental payments for 75 providers since Fiscal Year 2011.
Partnered with the state to develop the CPE program in 2018. Helped to capture nearly $9.7 million in supplemental payments for 28 providers.
Washington Ground Emergency Medical Transportation (GEMT)
Assisted over 90 providers in the State of Washington with GEMT cost reporting, generating $120 million in additional revenue.
Maryland Emergency Service Transporter Supplemental Payment Program
Provided cost recovery services to 9 EMS providers in the first year, generating
$62 million in additional funding.
California Ground Emergency Medical Transport
Following the state’s Medi-Cal Program re-activation, PCG is working with eligible providers to complete several years of cost reporting.
District of Columbia Reimbursement for Emergency Medical Ground Transport Services
Developed a Medicaid cost-based reimbursement program with the District of Columbia, generating $34 million in additional revenue.
How PCG can help you!
PCG has over 16 years’ experience working with state Medicaid departments and EMS providers to design, implement, and administer supplemental payment programs to obtain much needed funding for ambulance providers. At the state level, we help design, implement, and expand supplemental payment programs to increase Medicaid reimbursement. We also support hundreds of EMS providers nationwide with developing the supplemental payment cost reports, while maximizing revenue, maintaining compliance, and improving processes.
PCG’s consultants and cost reporting professionals assume the administrative burden throughout all phases of the design, development, and implementation of a supplemental payment program. Download PCG's Supplemental Payment Services data sheet to learn about the additional benefits and more!
Let the PCG team work for you! Contact us to learn more about how we can help.