|EMS Revenue Recovery|
Frequently Asked Questions
Q. When will Louisa County implement EMS billing?
A. Program implementation is scheduled for October 1, 2008.
Q. What is EMS Revenue Recovery?
A. EMS Revenue Recovery is a program that allows counties to bill insurance companies and individuals for the cost of emergency medical transport services. When a patient is treated and transported, the insurance companies, and then the patient, are billed for the services performed by the agency providers. Medicare, Medicaid and most private insurance policies already allow for reimbursement for this service.
Q. How are Emergency Medical Services (EMS) funded currently?
A. EMS is currently supported by County taxes, fundraising activities conducted by the volunteer squads, and private donations.
Q. Why do we need EMS Revenue Recovery?
A. It costs more each year to meet the needs of residents for quality EMS services. This is due to growth in population as well as continuous improvements in EMS technology, requiring upgrades or replacement of expensive equipment. Insurance (including Medicaid and Medicare) will pay for Emergency Medical Transports.
Q. How is charging for emergency medical transport service allowed?
A. The State authorizes counties to make reasonable charges for the use of emergency medical service vehicles.
Q. How does EMS Revenue Recovery work?
A. The patient’s insurance (Medicare, Medicaid or otherwise) will be billed first for the full service fee based on the level of care provided. There are three basic care levels: ALS Transport Level 1, ALS Transport Level 2, BLS Transport. Charges will also be generated for “Loaded” Mileage, which is when the patient is actually transported to the hospital facility.
Q. What are ALS Transport Level 1, ALS Transport Level 2, and BLS Transports?
A. The different transport types are based on the level of care a patient receives during an emergency transport. ALS 1 and ALS 2 are the two levels of Advanced Life Support and are given to the patient by a provider with a certification beyond EMT-Basic, such as a Paramedic. BLS transports are transports in which Basic Life Support treatment is given by an EMT-Basic or a provider with higher certification. The following fee schedule represents the fees that will be charged for Louisa County Emergency Medical Transports:
Basic Life Support (BLS) Transport $315.00
Advanced Life Support (ALS) Transport Level 1 $450.00
Advanced Life Support (ALS) Transport Level 2 $550.00
Ground Transport Mileage $7.50 per mile
Q. Will I be denied EMS services if I can’t prove I have insurance or money to pay the bill?
A. No one should ever be afraid to dial 911 for help. No person will ever be denied emergency medical service because of the inability to pay a fee.
Q. What if I can’t afford to pay the bill?
A. If any person is dealing with a financial hardship it is important to contact the County to discuss payment options. Through “compassionate billing,” the County has the capacity to waive or reduce fees when it is determined the citizen has a reduced ability to pay. Those who can not afford to pay may simply contact the County for other arrangements. A subscription plan will also be available to offset the co-pay and deductibles.
Q. What is the County’s Compassionate Billing Policy?
A. Compassionate billing is intended to eliminate or minimize out-of-pocket expenses for ambulance services for those that do not have the means to pay. Any person dealing with a financial hardship should contact the County to discuss payment options.
Q. What is the Subscription Plan?
A. Louisa County residents will have the option of joining an annual subscription service for ambulance transports. For a fee of $65 per household, any member listed under that household would be exempt from paying any portion of an ambulance transport fee, including deductibles and/or co-pays. For instance, if a patient enrolled in the subscription plan was transported, their insurance company would be billed, but the patient would be guaranteed that they wouldn’t receive a bill.
The subscription plan will have an enrollment period through the months of July through September of every year. New County residents will be given the option to enroll in the subscription plan within 90 days of their residency. In order to maintain updated information, please notify the County of any changes to your current household plan throughout the year.
Q. Do I need to enroll in the subscription plan if I have Medicare and a supplemental insurance?
A. Medicare covers ambulance services only if they are furnished to a beneficiary whose medical condition is such that other means of transportation would endanger the patient’s health. If the transport is considered medically necessary, Medicare will cover about 80 percent of the allowable charge and the supplemental insurance should cover the remaining 20 percent; however, it is recommended that you contact your insurance representative to verify.
Will health insurance premiums escalate after the County implements the EMS Billing Program?
A. The fact is that in most cases, health insurance premiums will continue to rise regardless of whether or not a community decides to bill for EMS transports. However, ambulance costs are less than one percent of health care expenditures. Billing at the allowable costs will have minimal impact on insurance premiums. With less than one penny of every insurance dollar spent on EMS transports, such programs have virtually no effect on health insurance costs.
Q. How does the billing process work?
A. The County will contract this service out to a private company to handle the process. The process is similar to that which happens when a person receives services from a doctor or other health-care provider. First, the patient receives the service - emergency ambulance transportation to a hospital. Insurance information will be obtained routinely, often at the hospital. Once the patient has been treated, a claim is sent to the patient's insurance provider.
Q. Will I have to pay for services if the ambulance does not transport me?
A. If you are not transported, there will be no bill. EMS Revenue recovery is based on what is termed "loaded service", whereby someone is actually transported.
Q. What if I am unable to sign a HIPAA form during the transport?
A. A signed HIPAA form is required before any of your information can be released from the hospitals. The billing company will mail you a form requesting your insurance information in order for your insurance company to be billed for the transport.
Q. How will my insurance information be collected?
A. The billing company will contact the hospital for your information. All information that is received will be kept confidential.
Q. How will my privacy be protected?
A. All Department members have been trained on patient privacy, Health Insurance Portability and Accountability Act (HIPAA) requirements and will strictly adhere to those standards.
Q. Who will I call if I have a billing or insurance problem?
A. The billing company will have customer service representatives to address billing and insurance questions. If you are not satisfied, you may contact the EMS Revenue Recovery Administrator at (540) 967-3499 or (866) 330-8272.
Q. How much money should be realistically expected through an EMS Revenue Recovery Program?
A. This varies from agency to agency, region to region and is difficult to compare because of the number of factors that are involved, including (but not limited to) demographics, location, percentage of insured patients, number of calls per day/month/year, type of billing level, individual-agency set fees for services, etc.
Q. Will billing impact the donations and fund drives for volunteer EMS agencies?
A. It is commonly heard that an agency that begins billing for services will see a significant decrease in the amount of funds collected from annual fund drives and donations to the agency. Most agencies and billing companies alike who have researched the statement have not found evidence to back up the claim. It has been found that billing for services has a minimal impact on annual fund drive and donation collections. The cost of providing EMS services continues to rise and volunteer EMS agencies will still need your help.
Q. Will EMS Revenue Recovery provide all the support needed to fund EMS?
A. No. It is hoped that the money collected through EMS Revenue Recovery will help pay for the additional operational and capital expenses that are needed in the next several years. However, EMS also has very significant expenses that will not be completely funded by EMS Revenue Recovery.
Q. How does this program benefit me (the taxpayer)?
A. Insurance (including Medicaid and Medicare) will pay for Emergency Medical Transports. It makes sense to generate revenue from the services provided. The other option would be to raise taxes. The majority of counties in Virginia are now successfully conducting revenue recovery programs in support of their EMS programs.
For more information, questions, or to schedule a community presentation, please call Kim Smith, EMS Revenue Recovery Administrator at (866) 330-8272 or email RevRecovery@louisa.org.