EMS Billing can be complex and time-consuming. It requires proper documentation, accurate coding, and timely billing to maximize revenue.

However, many EMS organizations lack the expertise and efficiency to maximize revenue in billing. As a result, they experience ballooning accounts receivable and aging balances, which are the biggest challenges that EMS organizations face. Worse, most organizations don’t even know why their accounts receivable are growing.

Even when an EMS organization can unlock additional profits by increasing utilization rate, billing can be a bottleneck that prevents them from realizing the associated cashflow. It is, therefore, absolutely essential that you take EMS billing seriously.

When faced with billing challenges, the logical solution for most business owners is to hire internally. But is that really the best business decision? This article will help you determine that.

If Hiring and Retaining Talent is a Challenge, Then It’s Better to Hire an EMS Billing Service

Even in 2023, the EMS industry continues to face a nationwide labor shortage. In many cases, even if hiring a quality employee can be accomplished, retaining that employee is still challenging. EMS organizations struggle to afford billing talent primarily because EMS organizations’ reimbursement is throttled by legislation, insurance, and other factors.

Say, for instance, you successfully hire an employee to handle billing. Just when billing operations are ramping up nicely, that employee may leave the job, which will completely disrupt your billing momentum. Not only will the constant hiring and onboarding drain resources, but it can also be emotionally taxing for both you and your organization.

Therefore, if you’re concerned about your ability to hire and retain talent, then it may be better to hire an EMS Billing Service instead.

For Small Organizations, EMS Billing Service can be Your Entire Billing Department

Smaller EMS organizations may not need a full-time EMS billing employee. In this case, rather than hiring a full-time employee who is not fully utilized, you can hire an EMS Billing Service to work when needed and pay them by project or by the hour. Plus, you get additional leadership, experience and expertise only available from experienced billing employees.

For Larger Organizations, EMS Billing Service can Fill in Labor Gaps

Larger EMS organizations with a sizeable billing department can also utilize EMS Billing Services to back-fill labor gaps. This includes unexpected maternity leave or a sudden influx of billing tasks or issues. EMS Billing Services can also plug whenever expertise gaps arise. For instance, they can handle tedious billing tasks while your team focuses on collecting receivables. Or they can help you collect receivables when your team is focused on financial reporting.

In-house Billing vs. EMS Billing Service: Top 5 Considerations

Not all EMS Billing Services are created equal, and not all employees are perfect for the job. When making the decision on whether to hire full-time employees or hire an EMS Billing Service, you need to consider the following factors:

1. Cost Effectiveness

While it may seem like an additional expense to engage an external service, a comprehensive cost analysis is necessary to evaluate the financial implications when it comes to hiring in-house or engaging an external service.

  • Staffing Cost: How much does it cost to hire an employee versus hiring an EMS Billing Service? Hiring, onboarding, and training require time and resources, and that expense could be significant especially when you fail to retain that employee. Further, if the employee is not fully utilized (when there’s not enough work), you’ll incur wasteful spending.
  • Training Cost: Will you need to train your potential employee or external service? If you can’t afford the proper expertise, then you’ll incur additional training costs so the employee is proficient in coding, documentation requirements, and compliance regulations.
  • Revenue Loss: Does the prospective employee have the necessary expertise to complete the job with minimal errors? A lack of expertise and experience will lead to revenue loss from billing errors and delays. Many EMS organizations face this issue today, which is yet another cause of ballooning accounts receivables.

By comparing the costs associated with in-house billing operations to the fees charged by EMS Billing Services, you can determine whether hiring an external service is the most cost-effective option.

2. Specialization and Expertise

EMS billing is subject to stringent regulations and compliance requirements. That means the employee, or the EMS Billing Service needs specialized knowledge in documentation and compliance set forth by Medicare, Medicaid, and insurance companies. Compliance with these regulations is crucial to avoid penalties and legal complications.

  • Coding Proficiency: Is the potential employee a Certified Ambulance Coder (CAC)? Are the staff members of the external service certified? Are they efficient and proficient in complying with documentation regulations – a necessary requirement for EMS organizations to get paid?
  • Documentation Experience: Compare documentation skillsets. Patient care reports have narratives, and the billers should be well-versed in matching the narrative with the necessary code to be compliant, reduce errors, and get paid on time.
  • Track Record: What does their work experience reveal? Request references from past clients or past employers to gauge their success in ensuring compliance and dealing with regulatory challenges. References can provide valuable insights into their expertise and reliability.

It is essential to hire an employee or an external service that possesses the necessary expertise to do the job. Doing so will reduce the risk of compliance issues to avoid significant financial and legal consequences.

3. Streamlined Billing Process and Efficiency

A streamlined billing process increases operational efficiency and maximizes profit. That means the additional labor added to your team should streamline, not hinder, your billing process.

  • Technology Proficiency: Is the prospective employee proficient with your billing software platform? If not, you will need to incur extra costs in training.
  • Software Integration: Is your billing software integrated with other modules, such as CAD and ePCR, to streamline the billing process? A streamlined billing process ensures faster processing and payment. It also increases the work efficiency of your potential employee or EMS Billing Service.
  • Clearinghouse Integration: Can the new employee work with your existing clearinghouse? Employees who have not worked with your clearinghouse will require ramp-up time to work efficiently. Any EMS Billing Service that doesn’t work with your clearinghouse will likely request that you switch clearinghouses. In both scenarios, your current billing process will be disrupted, bringing additional uncertainty and unnecessary risks.

If you have well-defined procedures and software systems for claim submission, follow-up, and appeals, then the right billing expert should fit nicely into your billing process without disruption. This allows your organization to operate efficiently, reducing the time between claim submission and payment receipt.

4. Billing Transparency & Revenue Maximization

Transparency avoids information misrepresentation and the uninformed decisions that follow. Not only do you need billing visibility, but you should also have visibility into the biller’s performance.

  • Reporting capabilities: Is the employee or external service capable of reporting on key metrics? Real-time access to billing and financial data is essential for making informed decisions to maximize revenue. Ensure the prospective employee is capable of providing detailed and customized reports on key performance indicators with financial insights.
  • Performance metrics: Are you able to monitor the biller’s performance metrics? Look for indicators such as claim rates, first-pass claim acceptance rates, and average days in accounts receivable. These metrics provide insights into their ability to deliver efficient and effective billing services.
  • Revenue Maximization: Is the new employee insightful and capable of making suggestions to maximize revenue? Being able to generate reports and performance metrics is one thing but decoding what the reports mean and how to improve is the important next step. Assess whether the potential employee or external service has experience in maximizing billing reimbursements.

To assess the above factors, ask what kinds of reports can be generated and what insights can be gained from them. For performance, ask what can be expected from their work using measurable metrics.

5. Onboarding and Termination

Hiring a full-time employee or an EMS Billing Service has different risks and costs associated with them. What if the employee wasn’t what you expected? What if the EMS Billing Service couldn’t perform their job? What are the costs of onboarding and termination?

  • Onboarding Process: How long will it take for the prospective employee to operate at max capacity? This touches on previously discussed topics of training cost, coding proficiency, and technology proficiency. The ideal employee is one who can start working efficiently out of the gate.
  • Termination Costs: What are the risks if you choose to terminate your new employee? For employees, it’s mostly the sunk cost of hiring, training, and onboarding. For EMS Billing Services, there may be a termination fee depending on the service provider.

To lower risks, most employers deploy a contract-to-hire model for full-time employees (although this model attracts less talent). If hiring an EMS Billing Service is the better business decision, then it is better to work with a service that doesn’t require termination fees.


If you’re a small EMS organization, deciding on whether to hire a full-time employee or an EMS Billing Service can be a big decision. Evaluate the cost-effectiveness, expertise, efficiency, technology, transparency, and the onboarding and termination process. For larger organizations, hiring a full-time employee or external service to fill in the gaps is more straightforward – you’ll only need to consider whether the added manpower can efficiently fit into your existing billing operations.  After your analysis, the decision on whether to hire a full-time employee or an EMS Billing Service will become clear.

If you need a diligent, transparent, and results-driven EMS Billing Service, Traumasoft recommends Versatile Revenue Management. Visit their website here: https://versatilerm.com/