How Better ePCR Narrative Documentation Increased Our EMS Transport Collections By 30%
Many EMS agencies lose over half their billing revenue without realizing it. This case study shows how one department raised EMS collections from 42% to over 72% — a $1.8M annual increase — simply by improving patient care report documentation. Learn how better ePCR narratives and medical necessity statements can transform your EMS billing performance.
For a long time, we assumed our collections were fine. We billed. We got paid. The numbers looked “normal.” But “normal” was only 42%.
Month after month, we billed around $595,000 for EMS transports — about 700 calls at $850 each. After contractual adjustments from Medicare, Medicaid, and private insurers, the allowable amount averaged around $475,000. Yet we were only collecting about $200,000 of that — roughly 42% of what payers actually allowed. More than half of our potential revenue was still being lost every month.
🔍 WHAT WE DISCOVERED
To understand what was happening, we conducted a comprehensive audit of every single transport and claim denial. The findings were clear — and uncomfortable.
• It wasn’t the billing company.
• It wasn’t the payers.
• It was our documentation.
Insurance reviewers rely heavily on the narrative portion of your ePCR — the story your crew writes — to decide whether a claim should be paid or denied. If that narrative doesn’t clearly support medical necessity, or if the patient’s condition and treatment details don’t align, the claim is flagged or rejected.
We found the same issues again and again:
• Missing or incomplete medical necessity statements
• SOAP narratives that didn’t match treatment or vitals
• Reports missing key reviewer details (why transport was required, what was done en route, what changed)
• Inconsistent explanations for the patient’s condition
⚙️ WHAT CHANGED
In December 2024, we made one focused change: we trained every officer on how to write accurate, complete, and defensible patient care reports (PCRs). No new staff. No new contracts. Just better documentation. By January, once every crew completed the training, the results were immediate.
📊 THE REAL NUMBERS
When we started the audit in October, collections hovered in the low 40s. By January, after the training, we saw a dramatic shift.
(Percentages below represent net collections of the allowable amount, not gross billed.)
• October 2024 – ~700 transports | ~$595,000 billed | ~$200,000 collected → 42%
• November 2024 – ~710 transports | ~$605,000 billed | ~$210,000 collected → 43%
• December 2024 – ~720 transports | ~$620,000 billed | ~$280,000 collected → ≈62%
• January 2025 – ~750 transports | ~$656,000 billed | ~$360,000 collected → ≈72%
• February–August 2025 – Avg 700–750 transports | ~$650,000 billed | ~$320,000 collected → ≈65–70%+
Before training: ~$205,000 collected per month
After training: ~$320,000–$360,000 collected per month
Improvement: Additional $120K–$150K per month, or about $1.8M annually — all from documentation accuracy.
❌ WHY INSURANCE COMPANIES DENY CLAIMS
It’s tempting to blame insurers, but most denials come down to four issues:
- Medical necessity not clearly stated
- SOAP narrative incomplete or inconsistent
- Vitals don’t match the patient story
- Transport rationale not explained
💡 WHAT WE LEARNED
• 40% collections isn’t “normal” — it’s a warning sign
• 70%+ is achievable with the same team and contracts
• The solution starts in the field, not the billing office
• Small documentation gaps can cost hundreds of thousands of dollars a month, depending on call volume
✅ ACTION STEP
Pull your last three months of reports. If your collections are under 60%, ask yourself: are we underpaid — or just under-documented?
➡️ WHAT’S NEXT
In the next article, I’ll break down how incomplete PCRs silently drain city budgets — even when call volume and staffing stay flat.
Questions? Email my directly: Raul@emssoap.com
Raul Gonzalez
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