Pricing and Price Quotes

Every dispatch in AngelTrack has a 'Price Quote' field.

Sometimes the price quote is set during call-taking, but usually it remains blank until late in the billing process. This is called lazy price quoting.

Cash register

Elements of a Price Quote

Every billable dispatch in AngelTrack eventually receives a price quote. The price quote is composed of the following elements:

Quotes given during call-taking

Dispatchers can quote whatever price over the phone, during call-taking, and AngelTrack will honor it. The price quote will only be overridden in two situations:

If no price quote is given during call-taking, the price quote will be automatically calculated using the three aforementioned elements. Automatic price quoting will happen later in postprocess, after the dispatch graduates QA; this is called "Lazy Price Quoting" and is discussed below.

Line-item service charges are separate

The price quote is independent of any line-item service charges that may incur. Those are recorded separately (in the dispatch's list of payment events), and considered along with the price quote when AngelTrack calculates the balance due.

Some line-item service charges in AngelTrack are automated, including cost for lab tests administered on-scene and for medications administered in the ambulance. To learn how to set up pricing and automatic service charges for these, read the Billing for On-Scene Services guide.

Price Schemas

Price quotes are calculated using one or more price schemas. A price schema contains a price schedule for each service level:

Price schema

In AngelTrack there is a built-in price schema for retail, which you must configure using the Pricing page.

Each of your facilities and affiliates has their own custom price schema: where filled in with prices, it overrides the retail prices. Similarly, your individual patients can have custom price schemas by creating custom "Patient rate" schemas. Each patient record is marked retail but can be assigned to one of the custom patient rates instead.

Whichever price schema applies, if its 50 datafields are not completely filled-in, then retail prices are used to fill the gaps... automatically. This is called "bleed through". In the price schema shown above, the blue datafields have been filled-in, while the white datafields have not. The white datafields therefore show retail prices bleeding through.

To learn more about contract pricing arrangements, read the Contract Pricing guide. To learn about the Federal Anti-Kickback Statute and its implications for contract prices, read the Anti-Kickback Statute Primer.

Retail prices are used to calculate insurance charges

When you code your insurance claims, AngelTrack calculates the charged amount by using your retail price schema. Of course the carrier is probably not going to pay the full retail price: they will demand a "contractual discount" and pay you as little as 20% of retail. But even if you know they are going to do this, you must charge the full retail price anyway because:

  1. Insurance carriers will never pay you more than you charge, they will only pay less than or equal to. There is zero benefit for asking for less than full retail.
  2. The retail prices charged are what create the ongoing "reasonable and customary" price for ambulance service. If all EMS companies charged insurance carriers less than full retail, then soon the insurance carriers would declare the "reasonable and customary" price was now lower, and immediately lower their allowed price to match.
  3. You must charge the full retail price if you later wish to deduct the "contractual discount" on your taxes. This is a large and valuable deduction, but if your accountant is not specialized in EMS taxes, he or she may not be aware of it (!).

Retail prices are protected against alteration

Because your retail price schema is so important, and is used all over AngelTrack, it is protected against casual modification. The only security role that is allowed to modify the retail prices is the Principal.

Probably there is just one employee who is the principal: it will be the owner or director or general manager. The designation of principal employee is made when your AngelTrack cloud server is first deployed. If you wish to change it, you must contact AngelTrack Headquarters Technical Support.

Price Quoting By Call-Takers

Price quotes AngelTrack uses lazy price quoting, which means the price quote usually remains blank until the middle of the billing process. The goal is to relieve dispatchers of that workload.

Of course the dispatcher always has the option to quote a price. Normally this happens only for a cash-pay service that has an up-front promised price. During call-taking, AngelTrack displays a small map showing origin, destination, anticipated mileage, and price calculations using one or more applicable price schemas (including retail of course). The dispatcher can then quote a price using whichever schema they wish.

When the quoted call is later invoiced to that patient, the recorded price quote automatically appears in the invoice, overriding whatever pricing schema you may be using for other customers. In this way, AngelTrack guarantees that the patient's invoice matches what was promised during booking.

Lazy Price Quoting

As we have said before, AngelTrack uses lazy price quoting: price quotes are calculated downstream at the billing office, rather than in the dispatch office.

As a dispatch moves through postprocess, AngelTrack attempts to automatically quote its price so that the billers don't have to do so manually...

Automatic quoting during insurance claim file

When you code a claim, batch it up for your clearinghouse, and then mark the batch transmitted, AngelTrack will automatically set the price quote equal to the amount claimed against insurance.

Normally this will be the retail rate, but the Coding page gives the option to claim one of the patient rates rather than retail. In any case, the amount claimed against insurance is written to the price quote field, from which the balance due is then calculated.

If the insurance carrier later adjudicates a price, AngelTrack stores the adjudicated price in the "Price allowed" field, which automatically eclipses the price quote and any service charges and discounts.

Automatic quoting during bulk claim file

If you are filing your claims on paper CMS-1500 forms, or if you are exporting calls into some other billing application, AngelTrack will still price quote them for you according to each call's coding. If the calls are not coded, then AngelTrack will price quote them at retail according to the service level determined by the QA reviewer.

This is done so that AngelTrack's many insurance/pending/revenue reports will have pricing data to show. Because Angeltrack cannot be certain that the exported calls were priced consistently, filed correctly, and received intact, all of AngelTrack's reports that show pending insurance amounts should be considered estimates -- not definitive. If you require definitive reports of insurance pending amounts, then you must use AngelTrack's electronic claims system.

This feature requires you to bulk claim file your exported items via the Insurance Filing Queue. It does not operate if you export your call data from an earlier point in the workflow; in that case your calls will remain unpriced until the EOBs come back.

Automatic quoting during a payment event

When using the Record a Payment Event page to process EOBs and payments, you are prompted to type in the amount charged (the retail price quote), the amount allowed by the insurance adjuster, and the amount actually received (if any). The amount received is then compared to the price quote and to the amount allowed -- whichever is less -- to determine if additional money still owed... typically the patient's copay.

Note that when the first EOB comes back from the insurance adjuster, the associated Dispatch record will probably not yet have a price quote set. You will set it as part of the process of entering the EOB, by simply typing in the retail charge shown on the EOB. You will also type in the amount allowed, which is usually less than the retail charge. (If the full retail charge is allowed, such as for out-of-network patients, then type the amount into the "Amount Allowed" field and check the "Update the price quote" box.)

In this way, your Dispatchers need never calculate prices for patients with insurance.

There is a second opportunity here for AngelTrack to automatically correct a missing or erroneously low price quote. If a Biller records a payment accepted, and elects to move the dispatch to 'Finished', then AngelTrack will automatically fill in any missing price quote with a calculated total of all payments received for the dispatch.

Automatic quoting during invoicing

The Invoice Generator is typically used to bill for dispatches not covered by insurance. This includes most or all of the wheelchair van transports, as well as BLS/ALS transports to non-covered destinations. Most such dispatches will not yet have a price quote set, because they were never submitted to an insurance adjuster.

If a dispatch already has a price quote set, then the Invoice Generator will honor it, ignoring the pricing schedule used elsewhere in the invoice.

All other dispatches -- those without a price quote -- will be automatically quoted during invoice commit, using the invoice's pricing schedule. The quoted prices are then saved to the dispatch records when you click the 'Commit' button, which also moves the affected dispatches to 'Awaiting Payment' and sets their Payor fields appropriately.

If any of the affected dispatches are later included by a different invoice, those quoted prices (saved with each dispatch) will be re-used, guaranteeing that the new invoice shows the same prices as any previous invoices. This allows you to change the pricing schedule for new dispatches while retaining the prices quoted for older dispatches; they can appear together in the same invoice.

Overriding Previous Price Quotes During Invoicing

If necessary, you can instruct the Invoice Generator to override any previous price quotes, forcing all dispatches in the invoice to instead follow the pricing schedule. If you then click the 'Commit', that pricing schedule will be forcibly applied to all included dispatches, overwriting any price quotes set earlier.

To do so, check the ☑ Override any quoted prices checkbox before generating or committing the invoice.

Normally you will override quoted prices only on facility or affiliate invoices, because they are governed by a contract.

Insurance Allowed Price

A dispatch submitted to insurance is subject to the insurance policy's price allowances. The allowed price is determined by the insurance adjuster; this is called adjudication. The adjudicated price is communicated back to you in the first EOB (i.e. the first X12.835 EDI, or the first paper ERA). From that EOB the adjudicated price will be recorded in AngelTrack, stored in a field named "Price allowed".

The "Price allowed" field is independent of the more familiar "Price quote" field.

Once a "Price allowed" has been recorded for a dispatch, all billing and payment functions treat that as the official balance due; the "Price quote", any service charges, and any discounts are thereafter ignored*. This holds true even if the insurance claim was denied and the bill goes straight to the patient, as insurance regulations require. To learn more, read how AngelTrack calculates the balance due.

*The price quote, the service charges, and the discounts are ignored when calculating the balance due, but they are still retained for later use in calculating your taxes.

Can be edited or deleted at any time

You can edit the Price quote and the Price allowed at any time, either from the "Billing" tab of the Dispatch Edit page, or while recording a payment event. If such a change occurs for a dispatch that has already been invoiced at the old (incorrect) price, the difference will be reconciled when the invoice is paid, and the dispatch may subsequently go through another round of invoicing to zero out its balance. For further reading, see the Invoicing guide.

If necessary, you can clear the "Price allowed", causing the balance due to revert back to the "Price quote" plus service charges and minus discounts.

Automatic override during facility invoicing

The Invoice Generator for Facilities offers an option to clear any "Price allowed" when invoicing a facility. Most facility contracts specify an exact price that will be charged, and the amount is independent of any insurance price adjudications, so this feature is enabled by default. To disable it for a specific invoice, simply untick the ☑ Clear any insurer adjudicated prices checkbox before generating the invoice.

Hospice Contracts

When handling patients whose transport bills are covered by a hospice contract, you will specify the contract prices under the facility record for the hospice agency. Then, mark the affected patients as residents of the hospice agency. Once that's done, the hospice agency can be marked as the obligated facility during call-taking. Now AngelTrack will automate the normally cumbersome task of assembling an invoice for a hospice agency.

To learn more about automating the billing of hospice contracts, see the Hospice Contracts section of the Patient Residence guide.

Charging a Bounty for Delegated Calls

If you charge your affiliates a bounty for calls you delegate to them, the bounty charge is not calculated or managed by AngelTrack. AngelTrack's price schema and invoicing system will bill for the service itself, not for the bounty.

In this situation the affiliate should be marked as ☑ Independent billing, meaning they handle the insurance and invoicing for the call; in AngelTrack the delegated dispatch moves straight to  Finished  as a non-billable item. You must tally up all such dispatches, export the list to a spreadsheet, and calculate the bounty yourself.

AngelTrack has a report specifically intended to help you do this: the Delegation History Report under Dispatch Home has flexible filters to assist you in zooming in to the list of calls you sent to each affiliate. From there, simply export the grid to your spreadsheet, and calculate the bounty in the spreadsheet.

Clear it with your legal team first

Receiving a bounty for the referral of patients covered by Medicare, Medicaid, VA, and other federal programs is addressed by the Anti-Kickback Statute, which has a specific exception allowing bounties for referral programs. Before beginning operations, consult your legal team to verify that your referral/bounty program complies with those regulations.

Use tags for multi-agency bounty agreements

If you have a contract to charge a parent organization for all calls delegated to multiple EMS companies, then the tags system will help automate the reporting process. Create a tag and instruct your dispatchers to apply the tag to any dispatch delegated under the contract. Later, the Delegation History Report can pull all calls that have the tag, giving you a single spreadsheet of everything delegated under the contract.

Discounted Rates for Certain Self-Pay Patients

If you have arranged with individual patients to bill them below retail, you may represent that arrangement as a "Patient Rate", which is a custom price schema that you can create and then assign to individual patients. You can create as many patient rates as you wish, and deactivate and reactivate them as you see fit.

Setting Prices using the Pricing Grid
Remember to configure the prices for all of the different services you offer

When customizing a patient rate, remember that retail prices "bleed through" wherever a specific price is not specified. So for example, if your retail price gives everyone the first 20 standby minutes free, and you wish to extend this to your custom patient rates, then leave those fields empty in the patient rate. The retail rate will then bleed through to the patient rate.

Once your patient rates are properly configured, you may assign them to individual patients. You can do so using the "Billing" tab of the Patient Edit page, or by using the Expand patient data popup editor. Your dispatchers can do this during call-taking, or billers can do it as they have time. Once a patient's record has a discounted rate assigned, AngelTrack will use it to estimate the cost of each trip during booking, so that the dispatcher can confirm it with the caller.

When generating invoices for a patient, each patient's price schema (be it retail rate or one of the patient rates) is shown next to their name, and the configured rates are automatically loaded into the invoice generator. As usual, you have the option to honor previously-quoted prices (promised by dispatchers during call-taking) or else override them by applying the patient's price schema to the actual mileage and services rendered.

Naming the patient rates

You can rename the "Patient rate" price schemas in order to help your staff remember what each schema is for. The name you assign will not ever be shown to crew members or to the patient.

Just click the appropriate "Edit" button on the Pricing page.

Deactivating and reactivating patient rates

You can deactivate a patient rate at any time. After deactivation, it remains in force on all patient records where it is selected, but it is not available for selection on new patient records.

Likewise, reactivating a patient rate does not affect any existing patient records; it merely becomes available for assignment.

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