By: Michael Campbell, News Editor
Appeared In: August 30, 2017 edition
DINWIDDIE – In the face of rising costs and the need to ensure they are maximizing their reimbursements from private insurers, supervisors unanimously approved a proposal to increase its ambulance transport fees for the first time in five years.
With the board’s approval, the county’s basic life support, or BLS, transport fee now increases to $475, advanced life support ALS1 is now charged at $600, advanced life support ALS2 has been adjusted to $800, and the gross total mileage is now set at $12 per mile.
The county’s subscription program would remain unchanged at $59 per household or $29 for a single person.
Prior to this month’s board action, the county charged $385 for basic life support or BLS, $470 for advanced life support, level 1 or ALS1, and $700 for ALS2 with a gross total mileage of $9 per mile.
During a presentation in July, Dinwiddie Fire and Emergency Services Director Dennis Hale explained those rates were set based on what the Centers for Medicare and Medicaid Services at the time of the last rate increase in the Dinwiddie in 2011.
His presentation to supervisors and residents in July served to break down the important role ambulance transport plays in terms of the revenue stream that goes into the county emergency services, helping pay for various training and the implementation of new items, such as Narcan and Naxolone as the county’s first responders are on the front line of the ongoing opioid epidemic that is gripping the region and nation.
Additionally, Dinwiddie’s emergency staff has increased by nearly ten since the previous increase in 2011, from 16 to 23, and mileage for transports have risen while they are still utilizing the same six ambulance units, which has resulted in higher maintenance costs to keep the fleet up and running.
According to Hale, “commercial insurance carriers typically reimburse at rates higher” than the current CMS rates and “contractual rates for commercial insurance carriers are typically 80 percent of billable amounts.”
“It would put us well below the Medicare and Medicaid minimums,” Hale said, noting Medicare is the county’s highest payer. “We are actually not maximizing what we can get from private insurance. Medicare is to pay us what they pay us, but our rates are not elevated enough now to guarantee maximum payment from private insurance.”
Over the past 12 months, Dinwiddie ambulances have responded to over 2,000 billable calls, per data provided by Hale and the department, with a majority of them being either BLS or ALS1 emergencies, generating a total of over 36,000 miles.
Additionally, of the $1.2 million in charges billed over the past 12 months, roughly 58 percent of those charges have been paid, totaling $715,786. Within those charges and receipts, Medicare billing was the largest in terms of charges and payments, representing 37 percent and 47 percent, respectively, but private insurances also have a significant portion of receipts for transports in Dinwiddie.
“About 25 percent of our collections come from our private insurers,” Hale said. “That is where we feel we are not maximizing what’s available to us for reimbursement.”
Self-pay charges continue to remain around 11 percent, with Hale saying those consumers are usually those with high deductibles or claims that were denied, with the rate of payment for self-pay being one of the lowest at eight percent.
Even with the increase, Dinwiddie’s transport rates would still be in the middle of the road in terms of what other jurisdictions charge, according to data provided by Hale with neighboring communities changing between $400 to $534 for BLS, $550 to $600 for ALS1, $600 to $918 for ALS2, and GTM rates ranging from $9 per mile to $14 per mile.
“It would bring is in line with what the market is in the area,” Hale remarked.
Following their approval in July, the new rates are formally in effect in the county.