Program in Crisis
Air Medical Service (AMS)
The air medical services (AMS) program in this case was
experiencing substantial financial duress and sponsoring
hospital leadership was in the process of evaluating several
options to mitigate the financial performance. Among the
options was to close the program.
The AMS program transitioned its billing and reimbursement
process to Quick Med Claims (QMC) in 2013. The billing and
reimbursement process for the AMS operation was historically
handled by the Patient Financial Services (PFS) group at the
sponsoring hospital. The reimbursement performance was below
the industry benchmarks.
The AMS program completes more than 2,000 patient transports
per year, including a mix of scene responses and
interfacility transports. The sponsoring hospital engaged
several different consulting groups over a five (5) year
period to evaluate the financial performance of the program.
Less than adequate reimbursement was identified by all of
the consultants as a contributing factor.
During the implementation process, the QMC team identified
several opportunities for improvement within the billing and
The reimbursement per transport was below $4,300. This
performance is well below the national and regional
There were a number of hospital driven processes that
resulted in a negative impact on the billing and
The documentation quality was solid, but opportunities
for improvement were identified.
The institution entered into a number of contracts with
commercial payors with reimbursement levels well below
their cost of operation.
The charge structure was not consistent with industry
best practices and the levels were well below the range
of charges in the region.
The QMC team worked with the client team to make a series of
changes in the billing and reimbursement process:
QMC assumed primary responsibility for the AMS billing
and reimbursement process. The majority of the processes
were changed to the QMC operating standard.
The QMC team continues to work with the leadership at
the sponsoring hospital to adjust the processes in order
to ensure compliance, maximize reimbursement and deliver
quality customer service to patients and families.
The QMC team provides regular feedback to AMS program
leadership regarding the quality of the documentation
and has offered educational programming to enhance the
The payor contracts were analyzed and QMC made
recommendations for action to mitigate the low
reimbursement levels in each case.
There was an initial charge structure adjustment at the
time of the transition and the sponsoring hospital
leadership plans to complete an additional adjustment in
2014 in order to make the structure and levels
consistent with the prevailing practices.