Why is Altavista EMS initiating a revenue recovery program?
Medicaid, Medicare and private insurance policies include the cost of EMS transport/treatment. As the need for additional EMS Providers continues to increase, both private/public service EMS agencies and/or similar services provided directly by local governments have sought ways to pay for these increased needs without drawing additional tax revenues to fund them. Other agencies and local governments across Virginia have found that billing Medicaid, Medicare, and private insurance for EMS transport/treatment services has resulted in significant revenues being recovered to fund EMS services. The known availability of such revenues for this cause has led Altavista EMS to seek such added resources to enhance services offered in the community.
How does this affect me?
If you have private insurance or are covered by Medicaid or Medicare, it will probably not affect you because you have already paid for the cost of EMS transport/treatment through your policy or coverage.
Why does Altavista EMS need this money?
The number of 911 calls being placed on Altavista EMS has risen dramatically in recent years. The increase in calls has challenged the ability of our EMS Providers to consistently meet the needs of residents and visitors in our community.
How will the money be used?
The primary intent of use of this added revenue will primarily be to fund career EMS Providers to be on duty during weekdays when most volunteer providers are at work and unavailable to volunteer. Added use of this funding will be to pay all remaining volunteers a small “pay per call” payment for all calls to which they respond where a patient is transported to a medical facility.
There are several reasons Altavista EMS has planned to take this approach. First of all, it is imperative that the addition of career providers does not discourage participation of volunteer providers. It would be impossible for Altavista EMS, or any of the localities serviced by Altavista EMS, to pay enough career EMS Providers to maintain adequate service at all times. Altavista EMS receives calls for service very sporadically; sometimes receiving 2-5 calls simultaneously thus causing staffing needs to jump from 2-4 providers to 10-12 providers in just a matter of minutes. If the integration of these (2) sources of personnel are unsuccessful, then Altavista EMS would still be unable to deliver higher levels of service which is our ultimate goal in initiating such a program. The final reason is to tie the small “pay per call” payment to the volunteer providers into an escalating scale based on their respective training levels. The intent of this approach is to encourage basic level providers to seek to become enhanced or medic level providers thus translating into higher levels of EMS Providers available for service by Altavista EMS in the community.
What percentage of this money will come out of the pockets of citizens?
Payments from individuals are expected to account for only 5% of total revenues recovered. The overwhelming percentage of the revenue will come from Medicaid, Medicare and insurance company payments. (including such added sources as automobile insurance coverage for accident related EMS needs and workman’s compensation for work related injuries requiring EMS) In many communities, nearly one half of the revenue is recovered from Medicare alone.
HOW IT WORKS
How does the billing work?
Altavista has entered into a contract with Diversified Ambulance Billing (DAB) to handle it’s EMS billing. The insurer, whether Medicaid, Medicare, or a private company, will receive the bill. Patients will not be billed until all insurance options are exhausted.
Will insurance generally pay my entire bill?
Most insurance companies pay 80% of the charges for EMS services.
If insurance pays, what will I have to pay?
If your insurance company pays, you are responsible only for any co-pays or deductibles.
What methods of payment will you accept?
The billing company accepts cash, personal checks, and money orders. (no credit cards accepted at this time)
What if I do not have insurance?
If you do not have insurance, Medicare, or Medicaid, a bill will be sent to you. If you are unable to pay in full, the billing agency will be glad to work with you.
ABILITY TO PAY
What if I am unable to pay?
Altavista EMS is developing a program with provisions to address these types of concerns.
If I have a balance to be paid on my bill, will I be refused?
No! Service will not be denied to anyone that has an outstanding bill.
EMS service by Altavista EMS?
Altavista EMS will not deny ambulance service to those with delinquent accounts or anyone else. This program will not change any EMS services now already available to anyone serviced by Altavista EMS regardless of insurance or any other factor(s). EMS Providers responding to a call for service will have no knowledge or concern of who has paid or who has not paid for services.
If Altavista EMS responds to my house but I don’t need transport, will I receive a bill?
No.
INSURANCE INFORMATION
Will my health insurance premiums increase as a result of this billing?
Unfortunately, health insurance premiums continue to rise regardless of whether or not a community decides to bill for EMS transport/treatment services. Ambulance related transports/services; however, represent less than 1% of health care expenditures. Across Virginia where agencies or local governments have implemented similar revenue recovery programs, there has been no reported evidence that EMS billing has resulted in any increase in health insurance premiums.
What type of information will I have to give when an ambulance arrives?
Persons requesting/needing EMS response are asked to provide any insurance information you have at the time of service whenever possible. Attending to the patient’s medical needs will always be the first priority.
What if I am not able to provide the insurance information at that time?
If your insurance information is not available at the time of service, the billing company will attempt to obtain the information at the hospital. If the information cannot be obtained, you may receive a letter asking you to provide the information. You can contact the billing company to provide the information. When the billing office receives the information, your insurance will be billed. You will not receive any further correspondence or bills until the insurance company has made a determination on your claim.
Will Altavista EMS file my insurance forms for me?
Yes, Diversified Ambulance Billing (DAB) will gladly file all insurance claims and forms.
RATES
What are the rates for this EMS service?
Altavista EMS will initially use a recommended billing scale from its consultant (DAB) based on reasonable/customary charges for similar services in other areas of Virginia. Once all localities serviced by Altavista EMS have established a fee scale for EMS services, Altavista EMS will have an identical fee schedule based on those established in each locality serviced by Altavista EMS.
Why is there a mileage charge?
A very large portion of the revenue that Altavista EMS anticipates collecting from this program will come from Medicare and Medicaid. Medicare requires mileage be included in determining the amount covered for EMS transport/treatment services and Medicaid calculates the allowable rate to be reimbursed based on mileage. Altavista EMS needs to be uniform in its billing practices therefore applying mileage to all bills.
What other nearby areas has EMS billing programs?
Nearby areas with similar programs include Halifax, Franklin, Martinsville, Chase City, Amherst, and the City of Lynchburg.
Nearly 80% of Virginia residents live in areas that have fees for EMS services. Nationally the percentage approaches 85%.
Will Altavista EMS still need donations?
Yes. Altavista EMS depends on donations to provide much of its total operating costs. Donations provide funding for such things as utilities, maintenance expense on ambulances, as well as major capital improvements such as purchasing new ambulances. Donations also cover the costs of disposables and other equipment necessary to deliver adequate services.
Altavista EMS’s primary purpose for involvement in a revenue recovery program is almost exclusively for the purpose of adding funding to assist in maintaining adequate personnel staffing to actually carry out the provision of services delivered to the community by the agency.