Friday, March 7, 2014

Details, details

Ann James, the unofficial ombudsman of Goochland County, raised some interesting questions about the Goochland Fire-Rescue Emergency Medical Services (EMS) cost recovery program at the March 4 meeting of the Board of Supervisors.

She contended that Goochland residents transported to area hospitals by county EMS received bills above and beyond their insurance coverage. When the cost recovery program was rolled out, there was a great deal of discussion about something called “soft” billing, which many interpreted as the exemption of county residents from payment in excess of insurance reimbursement.
Although told to “tear up” the bills, these citizens were concerned about negative impacts on their credit rating if they ignored the invoices. County Administrator Rebecca Dickson said that, according to county policy, these unpaid amounts will not be referred to a collection agency, and presumably have no impact on their credit rating.

Cost recovery, which went into effect January 1, 2013, is essentially a user fee for EMS. Revenues generated by the program, approximately $1 million gross billing resulting in payments to the county of about $545,000 net for calendar 2013, are used mainly to cover the cost of paid providers. The final total for 2013 may be higher. According to D. E. “Eddie” Ferguson, Jr., Deputy Chief-EMS, some claims are still working their way through payment systems that include Medicare, Medicaid and private insurance companies.

Charges levied by Goochland EMS are always a flat amount, said Ferguson. Itemized bills, he speculated, may be generated by hospitals that include costs for specific items and care given at the hospital emergency room, which is a separate entity from Goochland EMS.

The amount billed is the sum of the fee for level of care delivered and a mileage fee for the distance between the site of the ambulance pick-up and the destination hospital.

For instance, an advanced life support level 2 EMS call employing sophisticated treatment protocols that could include intubation and other life-sustaining miracles, costs $600. Transport is billed at a flat $8.50 per mile. An ALS 2 call with a 25 mile hospital trip would generate a bill of $812.50.

Basic life support transport for the same distance would be $400 plus mileage $212.50 equaling $612.50.
These charges are sent to the patient’s insurance company, Medicare, or Medicaid, which pays an established amount to the third party biller retained by Goochland to file claims for a six percent fee and bill patients for the remainder.
According to Goochland Fire-Rescue Chief Bill MacKay, bills must be generated for every ambulance transport so the county is eligible for Medicare and Medicaid reimbursement.

Ferguson contended that the use of an impartial third party billing firm that has up-to-date knowledge about regulatory compliance with all insurance programs, including Medicare and Medicaid, is essential to the success of the program.
Fire-rescue also hired a part-time person, Debbie Shaw. She oversees the paperwork involved in revenue recovery and serves as the department’s Health Insurance Portability and Accountability Act (HIPAA) compliance officer. She troubleshoots billing issues and works out payment plans.

Ferguson explained that while the soft or compassionate billing policy was intended to make sure that no one is ever denied EMS, anyone can tear up their bill without fear of repercussions.

Although there were rumored to be several options for recovering EMS cost in excess of insurance payments--including an annual flat fee per household subscription similar to that in Chesterfield County--on the table when the program was designed, revenue recovery, as presently constituted, was approved by the supervisors with little discussion. Perhaps Goochland’s population is just too small to make the subscription plan economically feasible.

The motives for cost recovery are pure. According to Ferguson, the county experiences NUA (no (EMS) units available) several times each week--sometimes on the same day--even with paid providers. Cost recovery was a way, in times of shrinking county revenues, to fund a vital service.

The methods of communicating the program to the citizens, however, were murky. Goochland needs EMS providers in place 24/7. We have an amazing corps of skilled and committed volunteers, but just not enough to keep up with the burgeoning demand for service.
Also, according to Ferguson, Goochland EMS responds to a significant number of calls on Interstate 64 and Rt. 288, transporting patients who do not live--or pay taxes--in Goochland. Cost recovery provides a mechanism to offset the expense of that service.
MacKay told the supervisors that contributions to fire-rescue increased by more than 40 percent in 2013, allaying fears that cost recovery would have adverse consequences for volunteer fundraising. It remains to be seen if the generosity of citizens will continue as they realize that EMS is no longer free. Will future cost recovery fee increases be necessary if too many citizens decline to pay their bills?

However, the term “soft billing” seems intentionally vague, perhaps to hide in plain sight the fact that no one—regardless of economic status—will be forced to pay more than the amount defrayed by their insurance. The frequently asked questions about cost recovery on the home page of the county website, make no mention of soft billing, but rather encourage the economically challenged to work out payment options with the county.

For the past six months, the supervisors have been working on a strategic plan, which is shaping up to be an attitudinal manifesto touting integrity and excellent customer service. The whys and wherefores of cost recovery have been a little squishy around the corners since the outset. This seems to be a contradiction for an administration that prides itself on transparency and a contradiction to the motivation behind the strategic plan.

After almost 15 months in action, it’s past time for better communication about the program. Ferguson said in recent months that he and MacKay have actively engaged in community outreach to explain the program (did we have to pass it before we could read it?)to church and civic groups. Call the fire-rescue office at 556-5304 for additional information.

Those seeking conspiracies should look elsewhere, but the county needs to be more open and precise about the details of cost recovery.

Also, bring your cost recovery questions to the town hall meetings scheduled for later this month. District 3, March 17, J. Sergeant Reynolds; District 1, March 20, Byrd Elementary School; District 2, March 24 JSRCC; District 5, March 26 at Manakin Company 1 Fire-Rescue Station; and District 4, March 27 at Grace Chinese Episcopal Church. All meetings begin at 7 p.m.

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