AGENDA DATE: 9/7/2022
TITLE:
Title
Emergency Medical Service Cost Recovery Rates
BODY
SUBJECT/PROPOSAL/REQUEST: ACFR requests the adoption of a new schedule of fees for Emergency Medical Service Vehicle Transport Services
ITEM TYPE: Consent Action Item
STAFF CONTACT(S): Richardson, Henry, Rosenberg, Farley, Eggleston, Mezzoni
PRESENTER (S): N/A
LEGAL REVIEW: Yes
REVIEWED BY: Jeffrey B. Richardson
BACKGROUND: On September 9, 2009, the Board adopted an ordinance authorizing the County to establish an Emergency Medical Service (EMS) cost recovery program, which would charge fees for EMS vehicle transports provided by the Department of Fire and Rescue and any volunteer rescue squad that applied for and was issued a permit to charge fees. The Board directed staff to establish a billing system to be operable by February 1, 2010.
On March 7, 2012, the Board adopted a Resolution to establish a new schedule of fees for EMS transports based on changes to the Medicare Allowable Rates and the updated “Usual and Customary Charges” paid by private insurance companies. The Board also approved the Albemarle County Resident Program, in which bona fide County residents are not responsible for any charges, including co-pays or deductibles, after all applicable insurance payments have been collected. Although this program was approved in March 2012, it was not implemented until July 1, 2014, due to the requirement that the County obtain an advisory opinion letter from the Department of Health & Human Services Office of Inspector General that the County’s Revenue Recovery Program met specific federal requirements.
After Albemarle County Fire Rescue (ACFR) staff’s annual review of the EMS Cost Recovery program and transport fees, ACFR staff believes it is appropriate to increase the fees, and is seeking Board approval of the fee increases as set forth below.
STRATEGIC PLAN: Mission - To enhance the well-being and quality of life for all community members through the provision of the of the highest level of public service consistent with the prudent use of public funds.
DISCUSSION: The Board of Supervisors adopted the current fees for EMS Transport in May 2016. Those fees, which were based on Medicare Allowable Rates and “Usual & Customary Charges” paid by private insurance companies, are as follows:
- $500 - Basic Life Support
- $600 - Advanced Life Support 1
- $850 - Advanced Life Support 2
- $15.00/mile
As part of staff’s annual review of the EMS Cost Recovery Program, ACFR consulted with the third-party billing company to conduct an analysis of our current fees. Based on Medicare allowable rates and commercial insurance reimbursements, the billing company provided staff a recommendation. Based on this analysis, ACFR proposes the following rates, effective October 1, 2022:
- $600 - Basic Life Support
- $720 - Advanced Life Support 1
- $1,020 - Advanced Life Support 2
- $18.00/mile
Increasing the fees to this level will allow ACFR to recover higher reimbursements from private insurance companies. Most transports are for County residents, and the County provides transport services to them at no additional cost over their insurance payment, so this increase will not be a burden to County residents. Instead, it will decrease the burden on County taxpayers by recouping reasonable reimbursements from private insurance companies. The County has a compassionate billing policy to address any non-residents that are unable to pay the County’s fees.
BUDGET IMPACT: This analysis assumes the new rates will be in effect for transport services provided on or after October 1, 2022. It is estimated that these new rates will increase our EMS Cost Recovery revenue by approximately $96,000.
RECOMMENDATION:
Recommendation
ACFR staff recommends that the Board adopt the new schedule of fees for Emergency Medical Services vehicle transport services resolution (Attachment A).
ATTACHMENTS:
Attachment A - Resolution