Billing For NEMT Services

Billing for NEMT services is a critical component of all NEMT providers' business operations.

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Billing For NEMT Services

As a business owner in the non-emergency medical transportation (NEMT) industry, it is important to have a deep understanding of the billing process for your transportation services. This is true whether you work in access transportation services (ATS) or special transportation services (STS), or if you are contracted to provide protected transportation services (PTS) on behalf of the state. 

A reliable, efficient billing system for NEMT services ensures you get paid for the services you provide, which is essential for the success of your business. Billing efficiency also saves time and effort for your service users and lets them get on with more important things.

If you provide patient transport as a home health agency, an assisted living facility, a hospital or clinic, or a dedicated NEMT provider, you could benefit from MediRoutes’ billing, reporting, and data integration systems. 

Billing for NEMT services is a critical component of all NEMT providers' business operations. Whether you need to automate NEMT billing for workers' compensation, NEMT billing for private insurance, or NEMT billing for managed care organizations (MCOs), you will no doubt be handling a huge amount of patient and insurance data every day. 

The MediRoutes system also works for NEMT billing for government and public programs, such as Medicaid or Medicare, which you are likely to need if you transport patients privately. These programs typically have specific requirements for billing and reimbursement. The system can also provide NEMT billing for brokers who contract with your business to move their clients. 

Whoever needs to be billed, the system starts with comprehensive reports. MediRoutes can keep an extensive range of reports related to billing and keeps a log of all trips completed, the time they took, and cancelled or late trips. Most importantly, the state-of-the-art system provides billing reports that include information such as funding source, insurance ID, date, run name, pickup address, drop-off address, number of passengers, miles driven, rate, trip ID, and client code. You can configure these reports to match the needs of the client you are billing, whether they are a broker, an insurance company, or a public program (including compliance with Medicare and Medicaid’s "Bill Accurately" requirements).

NEMT Billing Codes and Standards

You’re probably familiar with NEMT billing codes. These codes are used to identify the service performed by an NEMT provider and determine appropriate billing for NEMT services, including the amount that should be billed to insurance companies or other payers.   

Understanding NEMT billing codes and standards is vital for all NEMT providers to ensure accurate billing. Each code is specific to the type of service provided and used to identify the service on a claim form. Some of the most common code types used when billing for NEMT services include ground billing codes, reimbursement rates, and non-emergency medical transportation CPT codes. 

  • Ground Billing Codes: Ground billing codes and reimbursement rates are used to bill for ground transportation services, such as ambulances, wheelchair vans, and stretcher vans. The codes identify the transport used, mileage, tolls or fees, parking, staff involved, and location of the facility a patient was taken to or from.
  • Billing Code Reimbursement Rates: These codes and their rates vary depending on the payer, such as private insurance companies, MCOs, and government and public programs.
  • Non-emergency medical transportation CPT codes: CPT codes are used to identify medical procedures and services for billing purposes. Specific CPT codes are used for NEMT services to identify the type of service provided. The CPT code for transportation services is used to identify that service on a claim form.

Information on billing for NEMT services, billing standards, and CMS ambulance billing guidelines is discussed in detail in the Medicaid Transportation Policy: Non-Emergency Medical Transportation Policies and Procedures Manual.

If this sounds like a lot of information to juggle, that’s because it is. But the days of manually entering billing codes are over. MediRoutes lets you add coded billing items easily and repeat them with the click of a button, so your invoices always have the correct reimbursement rate for a given payer. 

NEMT Billing Software

All NEMT providers face unique challenges in NEMT services billing and revenue management. If you've been using legacy software, you know how traditional billing processes can be time-consuming, error-prone, and costly. At times, you might not know how to bill for non-emergency medical transportation, which is why many NEMT providers are turning to software like MediRoutes to streamline their operations. The MediRoutes cloud-based system can semi-automate billing for non-emergency medical transportation, allowing business owners like you to focus on providing quality transportation services to your clients. 

NEMT billing software offers a range of benefits for your business, including:

  • Increased efficiency: By automating billing processes, you can save time and reduce errors when billing for NEMT services.
  • Improved accuracy: NEMT billing software can reduce errors in your billing process, such as incorrect invoices or missed payments.
  • Enhanced revenue management: By tracking your billing activity and generating reports, you can gain insight into your revenue streams and identify areas for improvement.
  • Better customer service: By streamlining your billing process, you can provide faster, more accurate billing to your clients and improve their overall experience.

MediRoutes automates the billing process by generating invoices based on scheduled trips. This feature can save time, reduce errors, and improve efficiency. MediRoutes can also automate the entry of otherwise complex NEMT billing codes, making sure the correct codes are always used for every trip and payee.

Additionally, MediRoutes offers:

  • Real-Time Trip Scheduling: This feature lets providers manage transportation services more efficiently. You can see the current availability of vehicles, drivers, and passengers, ensuring efficient use of non-medical transportation services and drivers so time and money are not wasted.
  • Electronic Documentation: MediRoutes enables electronic documentation of trip logs, client records, and invoices. This feature can help you keep track of your billing activity and improve your revenue management for NEMT billing systems.
  • Claim Submissions: MediRoutes electronically submits claims to Medicaid, Medicare, private insurance providers, MCOs, and brokers, reducing the time it takes to receive payment and minimize mistakes that could lead to the rejection of your claims.
  • Analytics and Reporting: The MediRoutes system offers analytics and reporting capabilities to track billing activity and identify trends for NEMT billing, so you can make data-driven decisions to improve revenue management, billing, and more.
  • Automated Payment Processing: MediRoutes automates payment processing, allowing you to receive payments from clients as soon as they send them. No more payment method confusion, and no more chasing invoices. That means more time to do your real job: providing compassionate patient transportation and growing your business.

Whether you are a small NEMT provider or a large transportation company, MediRoutes can help simplify your operations and improve your bottom line. 

NEMT Invoicing and Payment Process

Due to the complexity of the NEMT codes and standards, and in turn its invoicing and payment processes, it is essential for all NEMT providers to have a reliable, efficient billing system for the NEMT invoicing and payment process. 

The process for billing for NEMT services, including invoicing and payment procedures, involves submitting claims, receiving reimbursements, and reconciling payments. The MediRoutes system can help with every part of the process. 

You know how important NEMT reimbursement and prompt payment is for your business. You may have taken great pains to input data correctly into old-fashioned tracking and billing systems and fill out NEMT payment authorization forms. The NEMT invoicing process involves submitting claims to appropriate payers, such as private insurance, workers' compensation, managed care organizations (MCOs), government and public programs, and brokers. Every claim must include accurate information, such as the patient's name, date of service, diagnosis codes, transportation codes, and more. Any mistake in the claim could lead to denial.

Once the claim is submitted, the payer reviews the claim and determines the reimbursement amount. The reimbursement rate can vary depending on the payer and the type of transportation provided. For instance, medical transportation-ground billing codes and reimbursement rates may differ from the non-emergency medical transportation policies and procedures manual. Again, mistakes could result in a denial or delay. 

Delayed or denied NEMT reimbursement and payment can occur due to several reasons, such as incomplete or inaccurate claims, missing documentation, or incorrect billing codes. In these cases, you as the transportation provider must resubmit the claim, leading to delayed payments, increased administrative costs, and wasted time. 

The comprehensive non-emergency medical transportation billing system offered by MediRoutes can help NEMT providers streamline their invoicing and payment process and improve the process through performance reports. If you want to grow your business, choose MediRoutes. Schedule a demo today for more information on billing for NEMT services in the most efficient way possible.

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