PRIVATE PAY CLIENTS:

These are clients who typically pay "out of pocket" for assisted transportation to and from medical appointments. They can originate from their own private residence, an assisted living or independent senior community, residential care facilities, or other.

In building your non-emergency medical transportation business, it’s my hope that you focus on building a strong foundation of private pay clientele because the rates of reimbursement tend to be higher as compared to other sources of reimbursement, and you have much greater freedom and flexibility for determining your rates and terms versus having to comply with various regulation from government agencies or entities.

As you'll learn in my material, I encourage you to build a diverse and dynamic business model with multiple sources of profitable revenue, but if the rates of reimbursement are not profitable, you don?t provide service!

I continue to work with a growing number of client-providers who only provide private pay and direct pay contracts and service agreement work because of the higher rates of reimbursement. For them, pursing lower forms of reimbursement simply are not worth their time and effort.

A high degree of private pay and direct-pay contracted work will definitely increase your margins and make your business more appealing when it comes time to sell your business.

DIRECT-PAY FACILITIES:

As we discussed, your NEMT services provides critical service to area hospitals, rehab and skilled care nursing facilities, assisted and independent living communities and more. As your presence in the community grows, you increase your capacity, and you demonstrate that you are reliable strategic partner, you can pursue formal partnership with area facilities in the form of direct contracts or service agreements in exchange for exclusivity.

Hospitals provide general discharges throughout the day and emergency room discharges mostly in the evening and midnight hours. A very small percentage of hospitals will provide local transportation, but the vast majority outsource all assisted transportation to local providers which offers you a wide variety of opportunity.

As a transportation vendor, most large hospital chains or medical campuses will require you to go through a credentialing process - typically administered by a third-party credentialing service. The third-party credentialing service will typically charge a fee, but the good news is that once you are credentialed and approved by the hospital you are typically able to service all of their affiliated facilities.

Hospital contracts can vary in size and scope, so typically it will be their legal department that will prepare a contract for your review with the help of your legal team.

In terms of payment, hospitals are typically direct-pay when transporting a patient from one hospital to another or to an affiliated facility. Many times, hospitals will pay for discharge transportation. Depending on the terms of your contract, they might require you to bill Medicaid when taking a Medicaid discharge and the hospital will pay for non-Medicaid transports. The scenarios are varied depending on the hospital, your negotiating skills, their leadership team, and their confidence in your service.

Many skilled care and rehab facilities will outsource all of their assisted transportation to local transportation providers while other facilities might operate their own vehicle(s). Sometimes their vehicle is used only for group outings and activities, but they will outsource all individual transports. The needs and dynamics of nursing facilities definitely vary based on size, location, number of residents, population percentages, and more.

Most assisted living and retirement communities will operate their own shuttle service to accommodate the transportation needs of their seniors and visiting family, but if transportation is required after hours, weekends, or out of area or their shuttle service simply isn't available, they will outsource transportation to local providers.

Hospitals are more likely to present you with a contract for review and signing while nursing and skilled care facilities typically request that you provide them with a service agreement for their review and consideration.

IMPORTANT: Establishing direct pay contracts with hospitals and facilities is literally a process. It takes time to build and cultivate a relationship of trust and reliability. Do NOT make the novice mistake of walking into a facility and requesting a contract or service agreement! They don't know you from the next person and have no idea or confidence that you'll even be in business tomorrow let alone show up on time. Timing is everything, and you need to ensure you have adequate capacity to meet demand before approaching the topic of contracts or service agreements.

Also, and this is important, please, do NOT embarrass yourself by using plug-n-paste or one-size-fits-all template agreements. NOTHING screams "rookie" or novice more than template agreements. If you present a facility with a generic plug-n-paste agreement, you're guaranteed to lose credibility. Their legal department will know you're a novice and easy to manipulate.

Seriously, when the time comes that you need targeted contracts and services agreements, contact my office to request assistance. I would even argue that your attorney is clueless because he/she has limited knowledge and understanding of NEMT particulars and nuances.

MEDICAID/BROKERS:

In addition to receiving free healthcare, according to Article 1915 of the Social Security Act, qualifying Medicaid recipients are entitled to receive free non-emergency medical transportation to and from medical appointments. The logic in giving free transportation to Medicaid recipients is preventive care.

Obviously, Medicaid will not reimburse for personal errands or outings - only medical related appointments.

Medicaid reimbursements are comprised of both state and federal funds. Therefore, as you can imagine, the processes, procedures, and rates of reimbursement will vary by state and even region.

An increasing number of states outsource their Medicaid transportation to brokers in an effort to reduce cost. The brokers then become charged with managing all aspects of the non-emergency medical transportation process - customer intake, provider onboarding, fleet and driver management and oversight, payment processing, and more.

Because Brokers are the middleman, they are directly part of the non-emergency medical transportation equation which means, as you can imagine, their "fingers can get a bit sticky!" More specifically, they can keep too much for themselves and squeeze transportation providers. For this reason, it's all the more important that you follow the strategies and principles that I share in my ebook, videos, and associated materials.

I'm not against signing up with various Medicaid brokers as long as their rates of reimbursement are profitable! Not all brokers are the same. You need to be prepared to pushback when necessary, cut them off if they prove overbearing, slow payers, or they prove to be a hassle on money owed.

As I'm sure you'll quickly gather from my material, I'm all about empowering YOU, the motivated business owner. We're in business to make more money, establish financial freedom and independence, and the last thing we want to do is enslave ourselves by being controlled by an overbearing broker that offers low rates of reimbursement. Therefore, as I routinely share and warn everyone when it comes to Medicaid broker, BEWARE! Don't ever let them (or anyone) take advantage of you!

MEDICARE INSURANCE:

Non-emergency medical transportation is not typically covered under Medicare Plans Part A and Part B. However, some Medicare Advantage plans (sometimes referred to as Part C) may cover transportation to and from doctor appointments if included in a group healthcare plan.

There is no current mechanism in place for NEMT providers to bill Medicare directly for non-emergency medical transportation. NEMT providers would need to bill the group healthcare plan directly who, in turn, will receive compensation from Centers for Medicare & Medicaid Services (CMS).

Click here to learn more about Medicare/Medicaid and associated reimbursement procedures for NEMT providers.

WORKERS' COMPENSATION INSURANCE:

Comp insurance is a no-fault system that will reimbursement for non-emergency medical transportation. Although you typically won't receive large volumes of comp trips as compared to other sources of revenue, the good news is that comp reimbursements are much higher as compared to Medicaid broker rates.

Insurance companies covering workers' compensation will contact you for a quote for which you would offer your private pay rates. The vast majority of the time the insurance company is going to accept and approve your quote but be sure to get written approval via email and/or fax prior to performing service.

Be sure confirmation includes (1) the name and title of the person giving approval, (2) the name and title of the person scheduling transport, (3) all client particulars to include name, number, pick-up location, drop off location, etc., (4) mutually agreed rates of confirmation, (5) payment terms, and (6) method of payment.