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Votes

Ambulance Billing To Start

Board of Supervisors adopted EMS fee schedule in 2004.

<bt>Fairfax County Fire & Rescue Department will be begin billings for emergency ambulance transport service April 1. And, that is not an April Fool's joke.

It is one of the last jurisdictions in Northern Virginia to begin charging for this emergency medical service. Alexandria has been charging for such service for more than 30 years. Arlington County has a long standing EMS fee policy. More than 70 percent of jurisdictions nationwide do.

However, the operative word in the explanatory brochure sent to Fairfax County residents announcing the change is "transport." If an ambulance responds to a call but, for what ever reason, a patient is not transported to the hospital there is no charge, according to Michael Neuhard, chief, FCF&R Department.

"But, this new fee policy does not mean that there will be any change in our priorities. First and foremost is service. Taking care of the patient is primary. I don't want my firefighters to think about anything but giving the best care possible to the patient," Neuhard said.

"They are not going to worry about billing or whether the patient has insurance or not. We are going to do this billing thing on the back end, after the fact. I want people to understand that we are going to take care of them as we always have," he said.

"No one will ever be denied service because of ability to pay or for lack of health insurance," he said.

Fairfax County residents with insurance, 92 percent, whether private or medicare, will never see a bill, according to Neuhard. "Someone who is uninsured or self-insured will get a bill. But, if they believe they are eligible to have the charge waived just send it back with an explanation. We will send out a bill three times if someone has not responded," Neuhard said.

"We are also going to follow a compassionate billing policy. That is why we are doing the billing under the guidance of the department. We have retained Diversified Ambulance Billing to handle that," he said. "But, they will follow our guidelines. There will be no harassment of patients."

DAB, headquartered in Virginia Beach, has 70 clients nationwide. They hold 47 contracts throughout the Commonwealth for services similar to Fairfax County, according to Neuhard.

OVERSEEING THE BUSINESS end of the new practice is Katie Mangione, program manager, EMS Transport Billing. "I am working with the billing company on a daily basis as well as our providers and other EMS staff," she said.

"We are making sure that providers do not charge or worry about the charges while they are in the field. The billing company has been on site here at headquarters since January helping us do all the set-up work on this," Mangione said.

"They have also been doing all the field training such as compliance with privacy regulations. We have contracted with them to provide support services through September if we need it," she said.

The county is paying no up-front money to DAB. "They will make their money through the net charge collections paid for by the health insurers. They will receive five and one half percent the first year, five percent the second year, and then four and half percent in years three, four and five. After that the contract is up for renewal," Mangione said.

Charges for EMS differ depending on the level of service required.

They are divided into the following categories:

* Basic Life Support (BLS) transport: $300

* Advanced Life Support, level 1, (ALS) transport for serious medical problems or traumatic injury: $400

* Advanced Life Support, level 2, transport for cardiac arrest: $550

* And $7.50 per mile from pick-up point to the hospital for ground transport

PATIENTS TRANSPORTED who do not have health insurance will be sent a request for information that will include a hardship waiver form, according to the brochure. "The county will waive the transport charge for financial hardship," it states.

If, for what ever reason, a patient's insurance company denies the ambulance service claim, "the Department will consider the charge uncollectible for county residents." However, this does not apply to non-county residents.

"We can not waive the co-payment for visitors to the county because the service is supported by county tax payers. But, even in these situations collections will be based on our compassionate guidelines," Neuhard said.

"Our hardship guidelines are more generous than any other in the region. They are based on a percentage of the poverty rate that is higher than any other county program," Mangione said.

"But, hardship is not limited to that poverty rate. Someone can have a high income and still be in tight financial circumstances at the time the service is rendered. This will be considered as well," she said.

With commencement of EMS transport billing, FCF&R Department will be subject to the regulations of the Health Insurance Portability and Accountability Act (HIPAA). "Because we will now be billing for these services we come under this act and we will strictly adhere to those standards," Neuhard said.

"WE ARE NOW in the process of conducting training for 1,800 personnel so that they are well informed of HIPAA regulations. HIPAA must be renewed each year and the contracts are based on third party billing," Mangione said.

Throughout the county's fire stations there are 35 ALS fire engines, 22 ALS medical units and 18 BLS ambulances. There are nearly 400 advanced life support providers "for residents and visitors on a 24/7 basis." They responded to 62,420 EMS incidents in 2004, transporting 40,949 patients, according to department statistics.

The total cost of a call by a two person BLS unit is $764.10. That increases to $861.58 if an ALS, level 1 unit is required. Included in those costs are: salaries of the crew; cost of vehicle use; per patient use; training costs; and indirect costs for overhead. An ALS engine is staffed by a four person crew.

In order to fully inform Fairfax County residents of the impending change the department has printed explanatory information pieces in four separate languages. They have also initiated a speaker bureau to spread the word to organizations countywide.

ALL OF THIS is summed up by the Guiding Principles in their brochure:

• Ability to pay will never be considered when providing service.

• Emergency Medical Services in Fairfax County will remain caring and compassionate.

• The Department will continue to provide the highest quality care possible.

• Implementation of a charge for EMS transport services will never diminish the way care is provided by county EMS providers.

"No one should ever hesitate to call 9-1-1 because of an inability to pay or lack of insurance. When residents need emergency services we want them to call without hesitation. Our commitment is to provide the best EMS care possible — period. Our philosophy always has been and always will be service first," Neuhard said.