Common NEMT Billing Mistakes That Cost Companies Thousands

NEMT billing errors are alarmingly common, and their financial impact is devastating. Industry data suggests that the average NEMT company loses 15-25% of potential revenue to preventable billing mistakes. That translates to tens of thousands of dollars annually for even small operators, and hundreds of thousands for mid-size companies.

Mistake 1: Not Verifying Eligibility Before Service

Providing transportation to a patient whose Medicaid coverage has lapsed or who is not eligible for NEMT benefits is the most expensive billing mistake possible — you have incurred the full cost of providing the trip with zero chance of reimbursement. Always verify eligibility before dispatching.

Mistake 2: Incorrect HCPCS Coding

Using the wrong transportation code is a leading cause of denials. Wheelchair transport coded as ambulatory, or stretcher transport coded as wheelchair, will be denied. Ensure your billing team understands the specific coding requirements for each trip type and each payer.

Mistake 3: Missing Filing Deadlines

Every payer has a timely filing deadline — typically 90 to 180 days from the date of service. Claims submitted after this deadline are automatically denied with no appeal rights. A systematic claims submission process that tracks deadlines is essential.

Mistake 4: Incomplete Trip Documentation

Claims require supporting documentation: pickup and dropoff times, patient signature, mileage, and trip verification. Missing any element gives the payer grounds for denial.

Mistake 5: Not Appealing Denials

Many NEMT companies accept denials without appealing. Studies show that 50-65% of denied NEMT claims can be successfully overturned on appeal when proper documentation is submitted.

Mistake 6: Manual Data Entry Errors

Typos in patient names, Medicaid IDs, dates of service, or diagnosis codes cause denials that are completely preventable. Automated data capture from dispatch systems to billing eliminates most manual entry errors.

Mistake 7: Ignoring State-Specific Requirements

Medicaid billing requirements vary significantly by state. Modifiers, documentation requirements, and submission formats that work in one state may cause denials in another. Ensure your billing process accounts for state-specific variations.

Mistake 8: Poor Coordination Between Dispatch and Billing

When dispatch and billing operate as separate silos, critical trip information gets lost. Integrated systems or clear handoff procedures between dispatch and billing are essential for clean claims.

Conclusion

Every billing mistake is preventable. The key is building systematic processes with proper checks, investing in technology that reduces manual errors, and working with billing professionals who specialize in NEMT. The revenue you recover will far exceed any investment in billing optimization.