BOS raising ambulance fees: SFD expects little/no impact on most “users”; patients with hardships encouraged to apply for abatements

by beth on June 26, 2019

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Above: After reviewing the costs and revenues for ambulance services, Chief Achilles asked selectmen to increase transport fees to estimated market rates. (image cropped from SAM video)

Last week, Fire Chief Steven Achilles asked selectmen to approve increased transport fees for ambulances. Convinced by the chief’s presentation and responses to several questions, the board unanimously agreed.

Achilles positioned the increases as reasonable and overdue. He forecast little to no impact on most residents. The data shows some patients could see a 45-49% fee hike (over $1K) for medical transports. But Achilles touted the need for the increase after 5 years of static rates. The new rate reflects the market*, and he expects the bulk to be covered by insurance carriers.

Selectman Marty Healey questioned if rate increases would point a spear directly at those who can lease afford them. He asked if “allowable” caps for the insured would mean that the only real impact would be those without insurance. He posited that those who don’t have insurance coverage are only “playing Russian roulette” because they can’t afford insurance fees.

Achilles responded by revisiting an earlier point in his presentation. He wants patients who can’t afford the bills to submit hardship forms for fee abatements. He told the board that after residents fail to respond to three bills, they are automatically sent the form. 

The chief stressed that those who can afford to pay their bills should do so. But he doesn’t believe that those who can’t afford the bill should be forced to pay. The Southborough Fire Department doesn’t send information to credit bureaus. But Achilles would like to use a collection agency to prompt those in arrears to pay up or submit their forms.

He also clarified that the intent is to increase reimbursements from private insurance payors.

Achilles is hoping for more than $50K more collected revenue, possibly even up to $100K. He assured Selectman Dan Kolenda that he wasn’t asking to overcharge to make money for the department. The fees will just further offset the cost of ambulance services. Before coming to selectmen with any future initiatives that cost money, he needed to ensure that he looked at ways to reduce the department’s burden on taxpayers.

The chief estimated that the SFD ambulance responds to calls over 1,000 times per year. Patients are only billed if they are transported to the hospital by ambulance. In his presentation, Achilles referred to 567 transports in one year. 

Of those transports, Achilles showed that 89% are for residents have some form of insurance. He said that those on Medicare or Medicaid (58%), won’t see any increase in their fees, due to the agencies’ low “allowable charges” caps. While 11% without insurance would see the increase – between hardship for residents and the already low collection rate for that group (17.6%) – that’s not the focus of the change.

The increase was requested for the 42% of transported patients that have private insurance. Achilles indicated they were sometimes charging less than some insurers’ caps. He referred to Westborough as successfully charging more. He also stated that the caps for private insurers tend to be based on the market rates for a region. Based on his research, the SFD was charging below market rate.*

Achilles couldn’t details what the impact to privately insured patients would be, given variety of plans. Some patients may see increases based on their deductibles. 

As for the Medicare/Medicaid allowable caps, Selectman Sam Stivers pointed out that they are generally based on the coding of claims. He asked Achilles if he was confident that the SFD was both accurate and complete in their bill coding. Achilles said he believes the SFD is strong in that area but with a little room for improvement.

Another area for improvement is acquiring the correct home address for patients. Sometimes they are picked up from other locations, which can be an issue for billing.

Given the number of responses to accidents on Route 9 and other roads, Achilles also hopes to tap into auto insurance for reimbursement. 

The chief promised to return next year to review the results of the rate changes. But he expressed confidence that the increased rates were a measured response to the situation – appropriate and sustainable.

You can see the presentation slides by clicking thumbnails below:

Ambulance Billing Rate Proposed Revisions page 1 

*Achilles “market rate” data was based on the average fees charged by their billing companies top 50 customers in MA and southern NH. 

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