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County's ambulance billing vendor says documentation, payer contracting improved collections to net ~75%
Summary
PCC told the Board its year-long work for Dallas County EMS included passing a Medicare targeted probe audit, adding Medicaid payer contracts, documentation training, and improving month-to-month reimbursements; PCC reported net collections (after contractual adjustments) of about 75% in their snapshot.
PCC representatives told the Dallas County Board of Supervisors on June 23 that their first year handling ambulance billing improved the agency’s reimbursement trajectory by completing a Medicare targeted probe audit, securing payer contracts (including Molina), and providing documentation training for crews.
Michelle Smith of PCC said the company stepped in after a probe audit was ongoing with the prior vendor; PCC completed the targeted audit and the county’s documentation practices were corrected and retrained so claims could be submitted and adjudicated correctly. PCC also reported contracting with Medicaid managed-care organizations to avoid the 20% reduction that applies to non‑contracted providers.
PCC reviewed monthly operational reports: Dallas County averages about 270–300 runs per month; a typical month had about 255 runs in the sample report, with 91 no-charge tickets (canceled calls, patient refusal, no patient found). PCC explained the difference between charge amounts and payments, noting contractual adjustments occur when claims adjudicate and that accounts-receivable snapshots can include pending adjustments. In summary PCC reported a gross collection snapshot of about 43% and a net collection percentage of roughly 75% after contractual adjustments, cautioning that old receivables migrated from the prior vendor affect those calculations.
PCC walked supervisors through program details that affect revenue: correct patient-auth-to-bill signatures for Medicare probe compliance, use of the Iowa GMT (ground emergency medical transportation) supplemental payment program that adds to Medicaid reimbursements, and opportunities to bill disposable supplies for some commercial payers. The vendor said it can generate additional customized reports (annual collection statistics, level-of-care breakdowns, time-to-submission metrics) and is developing a dashboard with a three-month target for initial features.
Board members asked about timing to submission, the process for changing level-of-care entry (BLS vs. ALS), and the point at which unpaid self-pay balances move to collections (PCC said a 120-day past-due process before referral to a collection agency, with options for inhouse small-claims or the Iowa setoff program). PCC said they typically enter claims daily once crew chiefs sign off and that they audit reports to confirm levels of care are billed correctly. The board did not take an action item for a fee-schedule revision but asked PCC and staff to provide a list of available reports and to continue monitoring collections and reporting.
