The scenario of USA healthcare system is changing with time and it’s mandatory that all entities follow such new norms and regulations. In such complex system, EMS agencies face a tough time in juggling between managing calls, trips, patients and budgets using their tools.
Additionally, the EMS agencies & stakeholders realized that they could not compare or communicate data seamlessly between tools unless there is a standard format. To control all these challenges, the industry has standardized a format call NEMSIS which is being supported by various solutions, especially ePCR Solution used by healthcare transport Providers.
What is NEMSIS?
NEMSIS stands for “National Emergency Medical Services Information System”, it’s a standard data format to organize & exchange the data elements collected by the EMS providers. With NEMSIS, organizing and sharing patient care data has become easy. It has helped building communication between service providers, state agencies and with any stakeholders.
Currently there are 2 main versions of NEMSIS – Version 2 and Version 3, and many ePCR (Electronic Patient Care Reporting) & Other applications still support version 2.x. However, from January 1, 2017, many States implemented latest NEMSIS v3.4.0 and shelf-life for NEMSIS v2.x being shortened.
NEMSIS v3.x and its importance
Since many agencies still supporting NEMSIS v2.x, it’s believed that they shall soon be upgrading to NEMSIS v3.x as States PCR Portals are upgrading to this version. There are 574 possible elements included in version 3 with 166 identified as National Elements (reference from NEMSIS website).
This version was important to match EMS data with patient’s electronic health records at the hospital. And the HL7 is an important step to include NEMSIS into the electronic patient care record, making a complete record of patient care.
Connection between NEMSIS and EMS billing
Some part of the NEMSIS was developed to meet CMS requirements for the patient condition codes that determine reimbursement to an EMS & Ambulance provider for emergency and non-emergency transports. The standardized data that NEMSIS provides can also support for faster and more efficient medical transports billing.
Government and Commercial payers require receiving medical transport (emergency & non-emergency) details/claims electronically in standard X12N 837P format. NEMSIS allows an EMS provider to export such billing/claim data (run or trips) from their ePCR solution and import it to a billing solution that supports such format. The billing system converts NEMSIS data to standard claim/X12N EDI 837P format that can be submitted to Payers for reimbursement.
With all the changes in the healthcare industry, to support EMS & Medical Transport providers to streamline their billing, iTech’s expEDIum Medical Billing Software supports latest NEMSIS V3.4.0 and some earlier versions. The expEDIum Billing Solution also allows integrating with an ePCR solution that supports such NEMSIS format using Web APIs/SOAP APIs or RESTful APIs.