Changes could leave ambulance service ailing
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Ambulance service director Leonard Madewell attended a recent Safety Committee meeting to go over the changes with commissioners after the ambulance service billing clerk received notification of the new regulations.
‘This starts Jan. 1, 2006, when all inclusive charges take effect,” Madewell said. ‘We can only charge two line items, a base rate and one other charge.”
Previously, the service could charge for a variety of line items, such as oxygen and EKGs.
‘We won’t be able to charge anymore for oxygen, EKGs, intubation or IVs. That’s automatically $195 we charge every trip that we use these items,” Madewell said, noting these items are required on most trips.
‘Probably 75 to 80 percent of your calls are going to have oxygen and IVs, and more than likely, if there’s anything going on, they’re going to have an EKG too, but we can’t charge them for those anymore.”
Madewell says there are some options to recoup some of the lost revenue, but not many.
‘The only way you can regain your money is to raise your base rate,” Madewell said. ‘The base rate now is $500 and $8 dollars a mile. Medicare will approve $9 per mile.”
Madewell said Medicare would have to approve any rate change, which can take some time.
‘The only thing wrong with raising your rates is it’s going to take about two years before you realize you’re going to get any money out of Medicare. It takes that long for it to go into effect before you can start collecting anything, if they approve for you to collect it.”
Medicare and TennCare represent the majority of revenue for the service, according to Madewell.
‘The way it’s running now, Medicare is about 65 percent of our calls, TennCare is about 19 percent, private insurance is about 15 percent and no insurance is about one percent,” Madewell said.
And in general, it is difficult to collect the full amount on some insurance.
‘TennCare we collect about 25.75 percent,” Madewell said. ‘Medicare is about 52 to 59 percent. And that depends on what we do for the patient when we pick them up, what kind of medical treatment we give and actually what’s wrong with them.
‘The private insurance, like Blue Cross or whatever you have as private insurance, not TennCare or Medicare, we can bill and collect the full amount,” Madewell said.
Madewell says the two government insurers only pay a percentage of what they judge the average cost of the run to be.
In addition, by cutting the allowed limit on line items Madewell said the loss of revenue with TennCare and Medicare runs would be significant.
‘Instead of $195 per run on those items, like oxygen, EKGs and IVs, we’re going to get about $5 to $7,” Madewell said.
Currently the ambulance base rate is $500 and $8 per mile, and the maximum allowed by Medicare and TennCare is $600 and $9 per mile, according to the information Madewell received.
Committee members decided to at least raise the base amounts to the maximum allowed in an effort to make up the difference in the cuts on line items.
‘I believe it’s got to be approved by the full court before we can raise anything,” Madewell said, ‘and then you’ve got to apply to Medicare and TennCare, so, like I said, it may take up to a year or two years before you see anything out of it.”
‘Everybody needs to be thinking this out,” said Safety Committee chairman David Grissom. ‘And then we’ll bring it up at the next commission meeting.”