U.S. EMS Billing Services Market Size, Share & Trends Analysis Report By Component (In-house, Outsourced), Competitive Landscape, And Segment Forecasts, 2019 - 2026

Industry Insights

The U.S. EMS billing services market size was valued at USD 1.3 billion in 2018 and is expected to register a CAGR of 8.9% over the forecast period. Rising incidence of medical emergencies in the region and surge in administrative costs associated with healthcare providers are the major factors driving the market. Besides this, soaring cases of chronic diseases, coupled with a rise in the geriatric population, are anticipated to fuel market growth.

Severe trauma cases and medical conditions such as heart attack, epileptic seizures, or stroke need immediate attention and high-quality solutions from EMS agencies, which in turn, spurs the demand for EMS billing service providers, thus enhancing market growth. Types of solutions offered by the EMS billing department include revenue cycle management, ambulance billing services for EMS, claims filing, denial management, patient accounting, practice management, and financial reporting.

The revenue cycle management process includes services such as enrollment with insurance companies, education and consulting, medical coding and submitting claims, capturing charges, remittance, third party follow-up, processing and rejections review, posting payments, and appeals and collections.

Acquisitions and partnerships are some of the leading strategies adopted by players in this market. For instance, in October 2016, EMS Management & Consultants, Inc. underwent a long-term partnership with the regional healthcare system East Texas Medical Center EMS (ETMC EMS) and 911 ambulance transport service providers called Paramedics Plus to offer revenue cycle management solutions.

Component Insights

Based on the component, the U.S. EMS billing service market is segmented into in-house and outsourced. To maintain strong cash flow, EMS agencies either opt for additional staffing in-house within the premise or choose to outsource to third parties. Queries within the in-house department can be resolved more quickly when compared to outsourcing. Outsourcing helps companies maximize their revenue, as it is less expensive than in-house management of the process. A majority of EMS providers in the U.S. choose to outsource the EMS billing process to reduce overall cost, optimize revenue, and reduce claim processing time.

Cost-effectiveness is the prime factor for outsourcing billing of EMS. Especially in the case of a start-up or during the transition, outsourcing makes the most financial sense. The process is more transparent as service providers are contractually obliged to provide all required services. With no interruption from outsourcers, they efficiently deliver comprehensive performance reports automatically or upon request.

Regional Insights

The U.S. market is expected to witness high growth over the coming years, attributed to higher health expenditure and implementation of a streamlined reimbursement framework in the country. The cost of administration of the U.S. healthcare system is significantly high, with billing and insurance-related (BIR) activities comprising a large share in the total cost. The cost of billing EMS is included under administrative cost, which includes billing of ambulance services provided to physicians and hospitals.

The cost of billing and insurance-related activities is covered by a mix of payers and providers. Based on revenue generated from the collection of claims by the payer in 2018, around 38.5% of the cost was covered by Medicare, 8.5% was covered by Medicaid, 47% was covered through insurance, and around 6% was covered by private payers.

U.S. EMS Billing Services Market Share Insights

Key industry participants offering in-house and outsourced billing of EMS in the U.S. include EMS Billing Management, LLC; Omni Medical Billing Service, Inc.; EMS Billing Services; Change Healthcare; 911 Billing Services & Consultant, Inc.; EMS Billing & Management Consultant (EMS|MC); The Billing Pros; PCC Ambulance Billing Services; and Pintler Billing Services.

The market is highly fragmented, with the presence of many players operating in the market at a national level. Mergers and acquisitions, partnership agreements, and launch of new service suites are some of the major strategies followed by industry participants. For instance, in January 2019, Change Healthcare made a strategic investment in MDsave, innovative technology, and healthcare payments company. The investment is a part of Change Healthcare’s initiative to improve the interaction between healthcare providers, payers, consumers, and employers in the healthcare payments and purchasing process. Together, the companies are working toward increasing price/cost transparency, reducing inefficiency, and lowering the costs.

Change Healthcare is one of the major players in the market in terms of strategic initiatives, market presence, and service portfolio. The company’s EMS billing solutions are used in 120 locations across the globe. The company has strong brand recognition in the Revenue Cycle Management (RCM) solutions market with advanced accounting platforms. Over the years, the company has undertaken numerous strategic initiatives to improve its EMS billing services, which has helped it gain a significant share in the domain.

Report Scope

Segments Covered in the Report

This report forecasts revenue growth at the country level and provides an analysis of the latest industry trends in each of the sub-segments from 2015 to 2026. For this study, Grand View Research has segmented the U.S. EMS billing services market report based on the component:

• Component Outlook (Revenue, USD Million, 2015 - 2026)

  • In-house

  • Outsourced