Walnut Township to bill for EMS transports
MILLERSPORT – Walnut Township Trustees unanimously agreed Tuesday night to bill for EMS transports.
Their decision followed a nearly two-hour presentation and question and answer period presented by Carl Reedy of MED3000. Reedy, a Thurston native, retired after 30 years in the fire service, retiring as the City of Huber Heights Fire Chief. He has started up EMS billing programs in 100 Ohio communities. In the lake area, MED3000 does billing for Basil Joint Fire District and the Village of Hebron. It has over 20 client departments in Fairfield and Franklin counties.
EMS billing started on the West Coast reaching Ohio in the early 90’s. Medicare is the key, Reedy said. It initially demanded “hard” billing for co-pays if it were to participate. “Hard” billing means that multiple attempts to collect are made and can include the use of collection agencies“Hard billing” was a tough sale.
The breakthrough, according to Reedy, was a Medicare Office of Inspector General decision in 2001 that local taxpayers have already contributed their share. Consequently, local taxpayers will NOT be billed for any co-pays or the difference between the department’s charge and the insurance payment.
Trustees approved an OIG program. Township residents, including those living in the incorporated villages of Millersport, Pleasantville and Thurston, will not receive a bill if they are transported by the Millersport or Walnut Township- Thurston squads. The township will accept whatever their private or public health insurance pays. If they don’t have health insurance, they will still NOT be charged.
Reedy said thanks to MED3000’s relationships with central Ohio hospitals, EMS patients will NOT have to show medics their insurance card. They or a family member will only have to sign a consent to bill their insurance company. The hospital will provide individual insurance information directly to MED3000.
Patients are likely to get an Explanation of Benefits from their insurance company, but it won’t be a bill. Patients who are not local taxpayers must be billed for co-pays per the OIG ruling, Reedy explained. In this case, that would be any who doesn’t live in Walnut Township. For example, a Buckeye Lake Village resident injured in a crash in Walnut Township and transported to a hospital would be billed for any insurance co-pays or the entire bill if they don’t have health insurance. They would have to billed at 30, 60 and 90 days to meet the minimum billing effort standard. There is NO requirement to send unpaid bills after 90 days to a collection agency.
Likewise, a Buckeye Lake Village resident or anyone not living within Walnut Township would also be billed if they were transported under mutual aid by Millersport or Walnut Township- Thurston.
Walnut Township could be ready to bill for transports in about a month, Reedy said. The first step is to prepare a credentialing package for submission to Medicare. Millersport Fire Chief Bill Yates gave its information to Reedy during the meeting. Thurston will be putting it together. The township will have to set up a lockbox at a bank to receive insurance payments. They must also set rates for the three standards of care:
• Basic life support - basic care from EMT’s such as bandaging, splinting and stopping bleeding;
• Advanced Life Support 1 (ALS1) - care by an EMT-intermediate or paramedic such as starting an IV and cardiac monitoring; and
• Advanced Life Support 2 (ALS2) - paramedic care such as cardiac arrest using multiple drugs. Common charges range from $500-600 for BLS to $800-$1,150 for ALS2. There is also a loaded (patient is onboard) mileage charge that ranges from $10-13 per mile.
MED3000 will get 6.5 percent of the payments for doing the actual billing. The fire departments will submit their transport run information to MED3000 via the internet.
Reedy said it takes Medicare about 90 days after receipt of the credentialing information to establish a provider number for Walnut Township. Once the township has a contract with MED3000 they can begin holding bills until they receive their provider number from Medicare. That number is used by the entire health insurance industry.
Reedy expects the township will be getting “decent” revenue in six to eight months since it typically takes an insurance company 45-60 days to pay a claim. Normal revenue levels should be reached in 12-14 months.
Each fire department will be paid their net (after MED3000’s fee is taken out) transport revenue every 30 days.
Trustee Terry Horn previously reported that MED3000 believes the township could generate $197,000 to $210,000 a year from transport billing based on past transport numbers. Initially the funds will probably be used to upgrade equipment like cardiac monitors, but as day-to-day operating expenses grow more of the billing revenue may go to operations, postponing an additional property tax levy to fund operations.
Reedy also addressed what he called falsehoods about EMS billing. “This is not a tax,” he said. “We’re bringing back insurance dollars to offset our costs. Reedy also said transport billing is such a small part of the health care cost that it isn’t even on the “radar screen” for insurance companies.