July 28, 2017 at 4:28 p.m.
Rhinelander fire chief explains ambulance billing procedures
Rhinelander fire chief explains ambulance billing procedures
Rhinelander fire chief Terry Williams also presented the committee with the breakdown by payor for those runs, as well as some other interesting statistics regarding medical runs his department made last year.
"I provided this report to provide a breakdown of what ambulance actually looks like," Williams told the committee.
The report included a pie chart showing what percentage each payee paid of the total calls. Medicare covered 48 percent of the runs while 30 percent were handled by private insurance, Medicaid 14 percent and 8 percent were classified as commercial insurance.
Williams said the "meat" of the report was on the second and third pages. He said he had a conversation with interim city administrator Keith Kost in regard to ambulance billing that resulted in the report.
On the second page, the ambulance revenue was broken down by month in three categories: charge based on rate, mandatory adjustments and monthly collection.
"So the rate that has been approved to be charged by Rhinelander Fire for ambulance service, that would be what we would send out as a bill," Williams said. "However, and here is where our numbers get changed around for us a little bit, the second column under mandatory adjustments, that is the true number that is billed out. If it were based on what our rate is set at, it would be the first column, our rate is not accepted by Medicare, Medicaid and insurance companies. It's all negotiated or determined ahead of time."
Williams used January as an example, explaining that based on the charges set by the council, the RFD should have billed $125,259.38 for the month, but after $54,171.26 in mandatory adjustments, the actual amount billed to the customers or insurance companies was $71,088.12.
While the report details how much money was collected on bills for each month in 2016, Williams said that doesn't correspond with the billing for that month.
"As you know, it takes time for that bill to get to that person and their insurance to accept or pay it," he said. "That just shows what we collected per month (on previous bills)."
If you compare the $442,460.59 total amount collected in 2016 on past billings against what the city could have charged, the collection rate would be bad, he explained. But when you compare it to the amount actually billed out after mandatory adjustments were taken out, which was $482,761.26, the city had a 76 percent collection rate.
"And the national average is 60 percent, so we're doing really, really good compared to the national average," Williams said.
Williams also shared breakdowns for expenses for typical ambulance calls comparing the approved rates with the allowable rates for both Medicaid and Medicare patients, which make up the bulk of the ambulance runs for the department.
"Medicare RFD rates for a basic life support, non-emergency call is $725," Williams explained. "Medicare allowable is only $220.20. So our mandatory adjustment we have to make on that call is $50 that we can't even bill for."
Williams said he compiled the report so that the committee could see what city administrator Keith Kost, finance director Wendi Bixby and himself will have to look at in terms of the 2018 budget.
"Because I believe there is a different way to do the budget that more accurately reflects what's being charged, rather than the pipe dream of $1.1 million," Williams said.
Committee member Steve Sauer asked if the department bills the county when RFD makes runs into the townships when county ambulances are on other calls?
"We charge directly to the patient," Williams replied. "So the subsidy that each township pays for the county ambulance service, Rhinelander Fire Department doesn't see any of that money. Matter of fact, the citizens of the city of Rhinelander are still paying that subsidy to Oneida County and we don't see any of that money. All we see is a patient bill, we bill the patient the same as if they lived in the city of Rhinelander."
"So other than for mileage, those Medicare and Medicaid rates are the same for someone who lives in the township as they would be for someone who lives in the city?" Sauer asked.
"Yes," Williams explained. "We charge mileage in the city, but the majority of the time, we don't drive far enough for the mileage to actually kick in. Where we make up in the townships is the mileage."
Williams also said the city and county ambulance rates are the same, other than that RFD charges non-Oneida County residents a higher rate.
Sauer asked if the city crews assisting the county with ambulance calls was costing RFD money. Williams said it wasn't.
"We actually make out a little bit. It's actually extra revenue for us," he said.
"We back up the county just as if we had a major incident here that would tap out all of the staff that we had, we want the county to back us up, too," said committee chair Alex Young.
"But we pay for the county ambulances to back us up," Sauer replied.
"Yes, you're right, but we send a bill if we go out there in the county, just as we would anybody else, so we get paid," Young pointed out.
Committee member Dawn Rog said she once had to call an ambulance and it took her insurance company six months to pay the bill. They claimed it was "outside of my area," she said.
"So it probably went back three times," Rog said. "So how many times does that happen where it takes six months?"
"A lot," Williams replied. "That's why I told you to not compare that last column with the middle, because there is no correlation between the two."
Williams said the RFD gets a lot of bills paid around time as the Department of Revenue intercepts state tax returns for outstanding bills.
"We actually pay LifeQuest a higher percentage to do those, but if we didn't do that we would be out that money altogether," he added. "Something is better than nothing."
Williams said LifeQuest, the EMS billing service the city uses, will actually come in and help fire departments more accurately project what they should budget for ambulance services.
"They will actually come up and help us set that all up," Williams said. "Keith, Wendi and I could sit down with them. Right now, there are numbers in the budget where we're going off the $1.14 million, well that $1.14 million is not a realistic number. We can go buy what our mandatory write-off fees are. We can get rid of all those extra lines and make the budget easier to understand."
Jamie Taylor may be reached via email at [email protected].
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