Bookkeeper for Nemt Companies

How does money come in?

For most NEMT companies, the money does not come from the person in the vehicle. It comes from a state Medicaid agency or a broker that the state pays, so your billing relationship is with a third party that was not in the vehicle.

That third party decides when you get paid. Some brokers pay weekly, some biweekly, some monthly, and a few hold back a percentage of each payment until they verify the trip happened. So a slow month can be a cash flow issue before it is ever a profit issue.

The rate is not negotiated per ride the way you would quote an auto repair. The trip type sets the rate, and the rates for a simple ambulatory trip are much lower than for wheelchair or stretcher.

These are ranges from industry sources, not a contract, so your actual rates come from the schedule of the broker you are under. Private pay trips exist too, and they may be more like $45 to $80 for a sedan ride with some states showing $375 to $650 for a stretcher, but the bulk of the money in this trade runs through Medicaid or broker payments.

What costs matter most?

The biggest expenses are the vehicle, the insurance, the driver, and the fuel, and the books have to treat each one as a decision, not just a bill.

A wheelchair accessible van runs anywhere from $16,000 to more than $80,000, and insurance on a medical transport vehicle can run $5,000 to $10,000 per vehicle per year. A driver costs the $17 an hour or more, and maintenance for even one vehicle can run $1,500 to $3,000 a month if you include tires, oil, and brakes.

The real cost per trip is what those fixed and variable costs add up to. If your driver is paid a day rate, you need to know how many trips that vehicle has to support the day. The books are what let you match a week of driver hours and a full tank of gas to the trip revenue that covered them.

Where do trip records break?

The biggest failure point in this trade is not arithmetic. It is a missing record that an auditor or a broker uses to reject a claim. When you bill a trip, you are promising that ride took place exactly the way the documentation says.

For every trip you need a patient name and Medicaid ID, date of service, the actual pickup and drop off times, origin and destination, driver name and signature, passenger signature, odometer readings, the license plate or fleet ID, an authorization or trip ID, and the correct billing code. Some states also want a proof the GPS route matches the most direct route, not a longer loop that adds a few dollars to your reimbursement.

This is not theoretical. In 2022, sampled New York NEMT claims failed documentation requirements 72% of the time, and the state projected roughly $196 million in improper payments, most of them from recordkeeping gaps like a missing signature or a trip code without a ride behind it.

What should you track separately?

Revenue should be separated by service tier, not pooled into one category like transport. You need to see ambulatory, wheelchair, and stretcher as three different work streams, because the rate and the vehicle cost for each one produce very different margins.

You also want your receivable ledgers broken out by broker. Payment slowdowns happen at the level, so a freeze with one Medicaid broker is not the same as a slowdown across the whole business. Keeping each broker in its own receivable account lets you see who is slow before the cash pinch shows the bottom line.

Denials and clawbacks deserve their own account too. Brokers can take back money they already paid if a trip does not verify later, and if you recorded that revenue as a normal claim at trip time, you book ended showing profit that never turned into cash. Track denials separately so the income statement stays honest.

Which reports matter?

The profit and loss broken down by trip type is the single most useful report a NEMT owner can asks. It is the only way to see that a stretcher yield a 20 to 30 percent net margin while the ambulatory rides run closer to 10 to 15 percent.

The receivable aging report by broker is your second-one. It tells you who owes you money, which broker is slow, and whether you can cover the next fuel or driver payroll check without borrowing.

The cost per loaded mile report is the third piece. Because your revenue often includes a per mile component, seeing driver time, fuel, maintenance, and insurance per mile a row lets you spot the trip where your rate never covers your cost.

What decisions can the books support?

The books should be able to answer whether you can afford another van, another driver, or a new route. If your wheelchair trips run at 30% margin and your ambulatory trips run at 12%, the list tells you where to spend marketing energy and which contract to pause on.

The same numbers tell you whether to hire a new driver or pay her overtime to cover a messy Friday. If the per trip revenue for a route does not clear the driver cost plus the maintenance per mile, adding a driver does not grow profit, it grows a hole.

No report tells you the exact future, but a set of books that ties each trip back to its revenue and its cost per trip and its cost per mile is what lets you price a route or tell a broker no that your side of the mat.