Questions about Ambulance Transport Revenue Recovery
January 31, 2005
1. Is billing for Ambulance Services a new idea or practice?
No. At least 70% of the country receives its pre-hospital EMS funded through revenue recovery (billing insurance companies). Attached at the end of this document is a “short” list of Virginia agencies currently utilizing or about to implement revenue recovery.
2. Will services be provided if the patient is uninsured?
No one will ever be denied service based on ability to pay or for lack of health insurance. The billing program is based on a concern for the medical and financial health of county residents. It is designed to minimize out-of-pocket costs for county residents by waiving any co-pays or deductibles after a patient’s insurance, Medicare, or Medicaid have been billed for transport services. Uninsured residents will be shown compassion and provided with the option of submitting a waiver form, ensuring that financial hardship is avoided. There will be no charge for emergency medical care if the patient is not transported. Patients who reside outside of the county will be expected to meet their co-payment and deductible obligations, but will also be treated with compassion concerning their financial obligations.
3. If the bulk of the money collected is to be used to fund 24-hour career medics, and a volunteer company would also like to bill, can they do so?
Yes, however if a volunteer company does bill, it must do so consistently for all transports per accepted policies and procedures. While it would be most beneficial for all companies to participate in the program, one or more of Volunteer Rescue agencies may opt to not bill.
4. If the career staff bills for services and is using volunteer-owned ambulances, will the volunteer company be compensated?
Yes. The current proposal anticipates transferring the mileage portion of the revenue recovery to the volunteer company who’s ambulances are being used by the career personnel. This is expected to be up to $8.00 per loaded mile. The total estimated funding earmarked for ambulance replacement is upwards of $200,000 per year based on three 24 hour medic units in service.
5. When utilizing mixed crews (ie: career and volunteer) which agency would be the primary beneficiary of the revenue?
In the case of a mixed crew, the policy would follow the VA OEMS (Office of Emergency Medical Services) lead agency guidelines. If a career medic is the AIC (attendant in charge) DFES would receive the primary transport fee, and the volunteer company would receive the mileage reimbursement. Anytime the crew is all volunteer, the volunteer agency receives the mileage and the transport fees.
6. How will this program affect donations to the county volunteer fire rescue departments? Does this program replace the need for volunteer funding?
No. Money collected goes directly into the DFES budget to fund paramedic personnel, except as noted in question four. The volunteer fire rescue agencies do receive financial support from Fauquier County through the Fire Tax Levy for some capital assets, however much of volunteer fire rescue agencies’ capital and operating expenses are covered by donations received from the community. The donations are still needed primarily to fund fire trucks. History has shown that donations do not decrease and in some cases actually increase.
7. Who will be the billing police? Procurement has already verified that we can ride the same contract as Fairfax County, who contracted with Diversified Ambulance Billing (DAB). They handle all billing, receiving and disbursements back to the county. The proposal does include the costs of upgrading one daytime Battalion Officer position to a 24 hour position. This person will ensure all EMS reports are reconciled each morning. DAB currently is contracted with approximately 65% of the EMS agencies in Virginia who are practicing revenue recovery.
8. What are the billing rates? A Basic Life Support (BLS) level transport will be $350, ALS-1(Advanced Life Support) $450 and ALS-2 $570. The mileage will be $8.00 per loaded mile.
9. What if, initially, this proposal does not generate enough revenue to fund three 24-hour medic units?
The proposal is to initiate billing for service and hire and place into service one 24-hour medic unit. Once the revenue stream produced can demonstrate it will support additional units, they will be added. It is anticipated this will be achievable within 12 months placing one 24 hour medic unit in the Northern, Central and Southern Battalions and one 24 hour Battalion Officer Centrally.
10. Will there be a need to provide more than three units? The need for 24-hour medic coverage has already been demonstrated. As the demand for service increases, there will be an increase in revenue. This program is proportionally self supporting. More calls, more revenue to fund more units.
11. Is HIPPA Compliance required for billing for services?
Yes. Any agency that receives federal funding is required to comply with HIPPA. Revenue recovery programs mandate HIPPA compliance. As an “emergency healthcare provider”, disclosure and patient acknowledgement signatures are not required. A 20-30 day window of time is provided to mail a notification of services to patients. This is required to be HIPPA compliant.
12. Are there any other associated benefits to Fauquier County Fire Rescue from revenue recovery?
The proposal calls for a PDA patient care reporting system. This has been a goal to implement to our current manual entry system. The PDA system can be funded by the revenue recovery system one unit at a time (one for each agency/ambulance participating in the program).
13. What specific demands for EMS services have and will continue to increase?
Beyond the obvious increase in residential homes, Senior Citizen housing (independent living, assisted living, and rehabilitation) includes the following institutions. These typically do not provide much in the way of donations, but create a large demand on services. The Warrenton EMS units respond to 3.4 calls per day at elderly care facilities. More elderly care homes are coming as well as age restricted communities. These runs would always be covered by Medicare/Medicaid. In the cases of two or more insurances, the copay could be covered automatically by the secondary or tertiary insurance providers. In any case, the individual would still never pay “out of pocket expenses”.
Warrenton: New Baltimore: Marshall:
The Oaks Suffield Meadows Marshall Manor
Warrenton Overlook (Under Construction)
Warrenton Manor House
Blue Ridge Nursing Home
Reference question #1, the following are a basic list of EMS agencies in Virginia, who are utilizing the ambulance revenue recovery program. Most listed here are contracted with Diversified Ambulance Billing company. There are several other ambulance billing companies in Virginia, whose clients are not listed here. There are several other localities who are considering the program.
Amherst County Department of Fire Safety
119 Taylor Street
Amherst, VA 24521
Cape Charles Rescue Services, Inc.
22215 South Bayside Drive, P. O. Box 3009
Cheriton, VA 23316
Chesterfield County Fire & EMS
10031 Iron Bridge Road
Chesterfield, VA 23832
City of Franklin Fire Department
100 S. Main Street, P. O. Box 179
Franklin, VA 23851
City of Hampton Fire & Rescue
1300 Thomas Street
Hampton, VA 23663
City of Hopewell Fire & EMS
300 North Main Street
Hopewell, VA 23860
City of Norfolk Fire & Rescue
100 Brooke Avenue, Suite 400
Norfolk, VA 23510
Colonial Heights Fire & EMS
A. G. Moore
100 Holland Avenue, P. O. Box 3401
Colonial Heights, VA 23834
Dinwiddie County Public Safety
P. O. Box 70
Dinwiddie, VA 23841
Halifax County Rescue Squad
Ms. Helen Compton
700 Hamilton Boulevard
South Boston, VA 24592
Hopewell Emergency Crew
P. O. Box 572
Hopewell, VA 23860
Lebanon Lifesaving Crew, Inc.
210 South Church Street, P. O. Box 61655
Lebanon, VA 24266
Nottaway Emergency Squad, Inc.
501 E. Virginia Avenue, P. O. Box 8453
Crewe, VA 23930
Parksley Volunteer Fire Company
18442 Dunne Avenue, P. O. Box 14
Parksley, VA 23421
Richmond County Rescue Squad, Inc.
6674 Richmond Road, P. O. Box 1785
Warsaw, VA 22572
Southside Rescue Squad, Inc.
810 W. Atlantic Street, P. O. Box 660
South Hill, VA 24370
The Community Fire Company
Ms. Maryanne Fithcett
3356 Main Street
Exmore, VA 23350
Additional agencies currently doing revenue recovery or in the process of initiating the program:
City of Newport News
Hanover County Fire & EMS
Prince George County EMS
Floyd County Emergency Services
Franklin County Department of Public Safety
Isle of Wright County EMS
City of Lynchburg Fire and EMS
Carroll County Emergency Services
Lancaster County Emergency Services
Fire and EMS