Niche Expertise

Not only are we experts in the financial industry as a whole, we're also experts in providing our services to the private ambulance industry. Our niche, industry-specific knowledge allows us to provide detailed and customized accounting services for our clients, which enables them to focus on what they do best while we're doing the same for their business.

JP Mohler has worked with more private providers of medical transportation services than any other CPA firm in Ohio. JPM is a member of the Ohio Ambulance and Medical Transportation Association and has an outstanding relationship with its leadership and members. We are deeply invested and committed to helping the industry solve their challenges, particularly with the continued and ever changing legislative and regulatory environment.

We understand that the private medical transportation industry is already heavily regulated and the new cost data collection requirement is merely an additional burden.

We also recognize that the profit margins in the medical transportation industry continue to shrink for many reasons outside the control of the business (e.g. shrinking labor pool, increased costs [labor, fuel, insurance, repairs/maintenance, increased regulatory burdens, etc.])

 

Medicare Cost Data Collection Update
As most of you know, in February 2018 Congress passed language directing CMS to collect ambulance cost data along with the 5-year extension of the Medicare ambulance add-ons as part of the Bipartisan Budget Act of 2018 (H.R. 1892). JP ...
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Areas where we learn about providers and their businesses, and questions that we ask:

Call Intake is where it all begins, and it can have a huge impact on the company’s profitability. If your call intake system is not functioning correctly, it impacts the entire process.

  • Who is answering calls?
  • How are staff trained (current and ongoing)?
  • What documentation is in place for call intake procedures throughout the year?
  • How are calls currently being answered?
  • What questions are being asked?
  • What data is being captured (or not)?
  • What notifications are in place for certain patients, ordering facilities, etc.?
  • Is there an automated process that can be replicated for any variety of calls?
  • Does any of the call intake data automatically populate in a run sheet?
  • What is your current process, and what tools/technology are you using to verify insurance?
  • How many runs are prescheduled vs on-demand?
  • How many days in advance are prescheduled calls reserved?
  • Are dispatchers reluctant to assign certain tasks for fear of upsetting the crew? 
  • Evaluation of deficiencies that delay billings (e.g. documentation, signatures, general completion during shifts, etc.)
  • Identification of training needs
  • Analysis of Technology (manual vs ePCR)
  • Identification of challenging facilities/doctors
  • Identification of staffing/training opportunities
  • Are daily runs being billed within an acceptable amount of time? 
  • If runs are not billed within 24 hours, what are the key reasons (e.g. PCS, crew documentation, etc.)?
  • What is the current process to have run sheets evaluated/corrected by staff?
  • What is the current process to have invalid PCSs evaluated/corrected?
  • Are there certain repeat offenders (staff, doctors, facilities)? If so, what systems are currently in place to mitigate this behavior (e.g. education, training, incentives, etc.)?
  • What are the daily billing goals (runs, dollar, etc.)?
  • How are tasks delegated to billers?
  • What is the protocol for when the primary biller/manager is absent from the office?
  • What is the daily average quantity of billing being batched?
  • Evaluation of clearing house and tools
  • Detailed review of accounts receivable reports to identify areas of risk
  • Who is responsible for monitoring commercial insurance, facilities, private pay, etc. and what are the processes in place to ensure optimal accountability?
  • Follow up, especially with private pay and facilities can be challenging, do you have the capacity to manage these functions?
  • What are the current daily run volume levels for each service type?
  • How many runs are prescheduled vs on-demand?
  • What is the level of daily runs required to achieve breakeven vs maximum profitability?
  • How many runs are declined each day and what are the contributing factors?
  • If run levels are not being achieved, why (e.g. lack of demand, staff call offs/no shows, cancelled runs, etc.)?
  • Does the team/crew have a daily run goal?
  • How many runs are you doing in each facility/per contract, average revenue per call, etc.?
  • What is your process for managing face sheets?
  • Review shift schedules compared to demands
  • Built-in overtime vs unplanned overtime
  • How are shifts assigned? Do you have a shift bid system?
  • When are crews dispatched during the day?
  • What times do rejected calls occur? 
  • Are you deploying your limited resources for the most profitable opportunities?
  • Evaluation of compensation structure components: hourly rates, shift differentials, on call pay, bonuses, retirement plans, health insurance, other fringe benefits, etc.
  • Because we work with so many providers, we are able to provide a confidential financial comparison to your peers. We are able to identify areas for improved cash flow and profitability based on our in-depth technical expertise on the industry.
  • Evaluation of key expense categories
    • Compensation
    • Repairs and maintenance
    • Fuel
    • Insurance (liability and health)
    • Federal, state and local income tax reduction, as well as indirect taxes (sales tas, commercial activity tax, fuel tax, etc.)