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Who pays for NEMT?

According to a transportation study, there are about 104 million NEMT trips each year at a cost of nearly $3 billion. For NEMT providers, this means huge potential for both starting and growing a business almost anywhere in the country. As long as there are people, there will be a need for transportation, especially when it comes to healthcare. So, who pays for all of these trips? If you’re thinking about starting an NEMT business, it’s time to learn how you’ll get paid, and what these different payers mean for you. 

Medicaid passengers

Passengers receiving trip benefits through Medicaid are the biggest population of NEMT customers. According to CMS, in order to qualify for benefits through Medicaid, a person must meet one of the following criteria:

  • Not having a valid driver’s license 
  • Not having a working vehicle 
  • Not able to travel or wait for transportation alone
  • Having a physical, cognitive, mental, or developmental limitation

If a person meets the above requirements, they will then be able to schedule a trip through a broker in their area. Every trip is different, and so is every passenger’s coverage. For instance, one passenger may need to be transported in a wheelchair van, while another could need a basic taxi vehicle. Both passengers have different needs, so each will have a different cost and potentially different coverage. One of the biggest factors of insurance coverage is the state in which the trip is taking place. Each state has its own rules and regulations for how much Medicaid will pay per trip, and the amount can vary per trip. If you’re a provider, the best thing to do is become familiar with your state’s Medicaid laws and expect that reimbursements could vary from time to time. 

Private pay passengers

Private pay passengers are a huge opportunity for NEMT providers. This group of clients doesn’t receive coverage through Medicaid, and therefore becomes a bigger investment for your business since you can set your own rates, hours, and fees. Private pay passengers are also more likely to book trips during off hours, like weekends and holidays, which you can increase your rates for. This group can be tough to find if you’re new to the industry, but once you have a handful of recurring trips, you’ll be in good shape. 

Get every penny you’re owed with non-emergency medical transportation billing software 

You don’t always have control over your reimbursement rates, but you can make sure you get the amount you’re owed with medical insurance billing software. Take control of your earnings by investing in a system that submits accurate claims on time, every time. Schedule your free demo with Claimgenix today!

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