🇺🇸United States

Unbilled Trips and Billing Errors in NEMT

2 verified sources

Definition

Manual trip logging and billing processes lead to unfiled claims, rejected reimbursements, and revenue disappearing through overlooked trips. Without automation, providers miss reimbursements from Medicaid and other payers due to inaccurate data entry, missing authorizations, and failure to capture all billable services like mileage and wait times. This results in systemic underbilling across recurring trips for elderly dialysis and therapy patients.

Key Findings

  • Financial Impact: $Thousands per month in lost reimbursements
  • Frequency: Monthly
  • Root Cause: Manual data entry from dispatch to billing creates errors and omissions in claims submission

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Services for the Elderly and Disabled.

Affected Stakeholders

Billing teams, Dispatch coordinators, NEMT providers

Deep Analysis (Premium)

Financial Impact

$1,000-3,000/month in claim processing delay costs, potential fraud losses, administrative overhead • $1,000-3,000/month in claim processing overhead and avoidable denials • $1,000-3,000/month per provider relationship in undetected underbilling; budget planning errors

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Current Workarounds

Excel spreadsheets and manual claim form filling to track and submit reimbursements. • Excel spreadsheets consolidating driver logs and coordinator notes. • Excel tracking of plan changes and trip data for reimbursement filing.

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Labor Waste in Manual Billing Reconciliation

$Hours of labor per trip batch

Delayed Reimbursements from Claim Denials

$Delayed payments eroding cash flow monthly

Billing Bottlenecks Delaying Trip Scheduling

$Lost trips due to operational delays

Failure to Timely Report Incidents Leading to Misdemeanor Penalties

$1,000 fine per violation

Misdemeanor Fines for Failure to Report Suspected Elder Abuse

$1,000 per violation

Medicaid Claim Denials and Non-Payment Due to EVV Data Errors

Commonly reported in trade literature as 2–10% of billable hours at risk during EVV rollout and ongoing for agencies that do not tightly manage EVV exceptions; for a $5M Medicaid personal care provider, this equates to ~$100,000–$500,000 per year in preventable lost revenue.

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