Ambulance rates approved; Medicare mandate requires change

Ambulance rates approved; Medicare mandate requires change by David Lias Medicare fee schedule mandates are forcing the Vermillion/Clay County ambulance to make changes in its billing methods.

The changes so far don't represent an increase in the city's ambulance rates. That may change, however, when the new Medicare fees are established sometime later this year.

"The government is doing some Medicare restructuring," Todd Koch, the city's ambulance director, told the Vermillion City Council Jan. 2. "They are mandating a new fee schedule that will be out sometime this year."

Koch said that the city has been informed that it will be paid a certain amount of dollars for Medicare patients, "and that's what we'll be able to collect. Currently we can collect past that amount, but in the event that we receive a new fee schedule, we'll have to write off what Medicare doesn't allow any longer."

In a memo to the aldermen, Koch noted that Medicare had mandated a fee schedule for all ambulances in the United States that originally was to take effect Jan. 1.

That new schedule hasn't been finalized yet, however. Koch said it likely won't take effect until this April or as late as this July.

The following ambulance billing modifications were made locally, Koch said, effective Jan. 1 to prepare for the upcoming Medicare fee schedule changes:

* The Vermillion ambulance will now bill all services and supplies in its base rate. This means that the cost of oxygen, c-collars, defibrillator pads and other supplies must be built into the ambulance service's base rate. The ambulance will be able to continue to charge for mileage separately.

* The Vermillion ambulance may consider implementing two distinct base rates, allowing the service to bill a non-emergency base rate and an emergency base rate. The rates will be at a Basic Life Support level currently being offered in Vermillion.

In the future, the ambulance service may set rates for a new emergency level of care termed Advance Life Support.

* All ambulance services will be mandated to change billing methods with the implementation of the new fee schedule in April or July.

The Vermillion ambulance, after providing services to a Medicare patient, bills Medicare and the patient's supplemental insurance. Any costs not picked up by Medicare or insurance are billed to the patient.

The city will no longer be able to follow this procedure after the new Medicare fees take effect, however. Vermillion will only be able to collect what Medicare allows for the charges, a 20 percent charge to patients and any deductibles not met. "We will have to write off the remainder of the charges," Koch said.

He noted that some cities have already raised ambulance rates because of the Medicare changes that will take effect later this year. Koch doesn't believe that Vermillion needs to increase rates yet, however.

"A lot of the ambulance services in the area have raised rates automatically, such as the city of Sioux Falls, and Yankton is looking at doing it," he said. "I think until we see what impact it will have in the end, though, we would be in too big a hurry right now to raise our rate. We may be just fine right where we are at."

A new Medicare mandate for this year requires ambulance services to charge all-inclusive rates.

Data that Koch supplied to aldermen Tuesday showed that a new all-inclusive rate structure for the Vermillion ambulance will generate about the same amount of revenue in 2001 as last year's old rate structure.

The ambulance service's charges from January through November of last year totaled $148,830. Koch told aldermen his calculations for the entire year's charges total $153,566.

"With the new proposed all-inclusive rates ? we've projected what we will charge out, and that will total $152,330. It's very close to what we charged out last year, so it's very much rate increase neutral," he said. "We will be billing out close to the same amount as we did in 2000."

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