In Revenue Cycle

In today’s era of increasingly tight budgets and rising costs, emergency medical services (EMS) are looking for new ways to strengthen their financial footing and add value for constituents while sustaining the highest quality emergency services.

EMS subscription programs – which entail households or businesses paying an annual flat fee to cover emergency medical services and/or emergency transport-related expenses — have become a popular means of generating supplemental income for EMS departments.

Subscription programs have existed for decades in some rural, underserved areas of the country. But the approach is gaining traction among EMS organizations nationwide to help offset transport write-offs and the increased costs of advanced care equipment and services.

At the same time, subscriptions appeal to the growing segment of the population covered by high-deductible health insurance plans. With some plans, deductibles or co-pays can mean the patient is responsible for the entire cost of emergency service or transport. Transport costs nationwide typically range from $350 to $1,400. In most cases, subscription services cover only emergency ground transportation. However, some agencies cover only on-site services and not transport. Non-emergency transport and air ambulance services generally are not included in subscription services.

Automated sign-up and renewal

A leading EMS agency in the mid-Atlantic area has partnered with Change Healthcare to automate its long-running subscription program.

Under the program, households make a $60 annual contribution to a county fund and are covered for any costs associated with emergency transport for any household member for one year. The voluntary contribution, or subscription, guarantees that patients won’t face out-of-pocket expenses should the need for emergency transport arise.

As part of a recent contract to provide revenue management services agency, Change Healthcare will manage the subscription service on the agency’s behalf. For the first time, an Internet-based platform will enable county residents to subscribe and pay for EMS subscriptions via a secure web portal.

EMS officials hope automation will help increase participation in the program and boost revenues for the agency. Currently, approximately 20,000 households representing about 45,000 individuals are signed up for the service.

The web-based portal developed by Change Healthcare for managing online subscription sign-up, payment and renewal is being offered to other EMS billing clients and is also available to agencies on a stand-alone basis.

Legal issues

EMS organizations considering the creation of subscription services need to be aware of state laws that could affect the program. For example, state insurance regulations may or may not permit the creation of a subscription program, since the service effectively amounts to an insurance policy.1

In addition, Medicare Anti-kickback statutes require that a number of conditions be met in order to obtain appropriate waivers from the Centers for Medicare & Medicaid Services (CMS).2 Medicaid also provides guidance for subscription programs. Organizations should therefore consult legal counsel in order to establish a sound legal footing for their program.

Find a partner that can help optimize the subscription program

EMS subscription services are a valuable option for underinsured residents and those struggling with the cost of high-deductible plans. They also represent an important new revenue source for EMS agencies. However, creating and sustaining subscription services means more paperwork and accounting burdens. That’s why it makes sense to partner with a vendor that can automate the process and also deliver comprehensive revenue cycle services to help agencies optimize reimbursement and strengthen reporting.

As a leading provider of EMS billing and revenue cycle services to first responders in both rural and urban areas nationwide, Change Healthcare understands the value to both residents and agencies that a streamlined subscription service can produce.

To learn more about our EMS billing services, visit

1 “Keep Your Subscription Program Legal,” The Journal of Emergency Medical Services, Sept. 30, 2007,
2 Ibid.

According to the Healthcare Information and Management Systems Society (HIMSS), charge capture errors or missing charges should occur on less than 2% of accounts or claims as a best practice standard. And, as we know, that 2% can equate to millions of dollars per year for a typical health system. Charge capture ...

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