Most know that EMS serves a population that is often older or of more limited means than populations that may be served by other medical providers.
Because of this fact most EMS providers “payer mix” is heavily weighted towards Medicaid (needs based) and Medicare (generally age based).
Medicare and Medicaid, as well as other smaller government health care programs, only pay a designated amount for EMS services, regardless of your billed amount. These amounts are established in each program’s “fee schedule”.
This reality is a consequence of state (Medicaid) and federal (Medicare) law and is, unfortunately, not optional.
The following “Payer Mix” sample is representative of most of our region. Over 70% of all charges are controlled by “fee schedule”. These percentages certainly indicates that fee schedules control the vast majority of EMS calls.
Despite their importance, few EMS leaders actually see their fee schedules.