Fire district looking to balance out ambulance fees

DAYTON - More information is needed by Central Lyon County Fire District officials before they decide whether to stay with a multi-agency billing cooperative or hiring a private ambulance billing firm.

Board members also said that they want more information before deciding whether to continue paying for collection agency services.

Board member Richard Forant said, "We are looking at a lot of different avenues and ways we want to go with this (billing). I would like to investigate further, talk to other agencies and bring this back for discussion at a future meeting."

With the majority of the losses attributed to a low Medicare reimbursement rate and a high percentage of indigent patients, the district wrote off $252,123 in uncollected ambulance fees in fiscal year 1998-99. District Chief Bill Driscoll said about 40 percent of all bills generated from ambulance service calls go uncollected.

The billing cooperative was formed to save member fire districts money. Invoices are generated by the Carson City Emergency Medical Services Division under the direction of Chief Vince Pirozzi. Each of three fire districts pay an annual fee based on billings generated. Central Lyon County pays $10,000; Carson City, $58,000; and Douglas/Tahoe, $14,000.

"This coop was formed because we decided we each had a common interest in billing services - to save money for everyone. Our rates are lower because we are not in it to make money as a private enterprise is," Pirozzi told the board.

Membership fees increased this year due to the North Lake Tahoe Fire District leaving the coop. Pirozzi said if the coop loses another member it could become too expensive for the other members.

Representing the private AIS billing service, Dan Kehoe said his company's fees are determined by a 7 percent charge on district billing income. Based on an estimated income of $220,000, the district would pay about $15,400.

Kehoe said, "We are looking at a 71 percent collection rate here, compared to the current 60 to 62 percent success rate. We can increase your revenue and save in manpower costs. You provide us with the documentation and we will do all the work to get the reimbursement.

"We want to work with you. If we don't collect, we don't get paid."

Bills not paid after due process are turned over to a collection agency. For the past six years the central fire district has contracted with a collection agency to pay 30 percent of whatever is collected. If a case is pursued through the courts, costs increase to 50 percent.

With the mandated Medicare writeoffs comprising the majority of the uncollected revenue, Forant asked if collection agency services are worth the effort.

"If the problem is not with the coop, perhaps we need to look at the process. Maybe we should eliminate the collection agency if the return is not that good," he said. "I am not after the retired guy on a fixed income, or someone who is trying to pay a little at a time. I am after the one who has a job and just won't pay."

Medicare pays a flat reimbursement rate per patient for ambulance services. The reimbursement rate for Central Lyon County is considerably less than other districts.

Carson City receives an 85 percent reimbursement rate from Medicare while central Lyon County receives only 15 percent. About half of central Lyon County patients are on the Medicare program. Federal law requires that all ambulance services must accept Medicare patients and that unpaid portions of such bills must be written off.

For years Central Lyon County officials have tried unsuccessfully to find out why they are treated differently, officials said. Following recent contact with a Medicare official, however, Driscoll said he now has some hope of finding a solution to the problem.

"(Medicare representatives) said the rates are based on 60 month periods of past service history. It just depends on when it was done. We need to do a new survey and she said she would pursue it," Driscoll said. "Hopefully there is some hope there."

According to Pirozzi, Central Lyon is locked into its collection problem and it won't be solved until they get Medicare to change its reimbursement rates.

"Your primary problem is Medicare. A billing company will not fix it. The Feds will pay only what they pay now no matter who does the billing," he said.