EMS, Billing, And Taxes

[x635 4,066]

Here's a question I have for all of you, and I'd love to hear your opinions.

Say you live in a Town where you recieve municipal Police and EMS funded by taxes.

If you need an ambulance, is it fair to get a bill from that tax-supported agency?

My thoughts are- you pay a LOT in taxes for this and other town services- and you use them and get a bill?!?!

Also, is this legal to do?

I'm not even going to get into the ethics of billing MOS's.

[Guest]

Tough question. Like you said, Seth, we all pay a heck of allot in taxes and combined, they should equip our local governments with the ability to provide us the protection (Fire, EMS, Police, etc.) we need.

EMS, as i know you know, is extremely expensive. I'm not a finance man and don't know a whole lot about billing procedures etc, (i just know that i get yelled at if i don't get the patient's John Hancock!). With that said, i can't imagine tax revenue is enough to completely support an EMS agency...which is often at the bottom of the barrel in terms of who gets the money and how much they get. Billing your insurance company probably offsets a tax increase. But, the only one who knows the answer would be the director of an EMS agency.

Is it fair? Well...not completely, but if the situation was pay taxes and submit a bill to insurance or we are going to have to cut trucks, i would say ill pay the taxes and take the bill.

[paratrooper75 41]

One way of looking at it to think of EMS as a medical service. Just like a doctors visit, ER visit, dentist, etc. All of which you pay by insurance. The taxes off set the money needed to keep things up and running; building costs, ambulances, maintnence, equiptment. The bill is for the service that was provided to the patient with a set cost depending on the treatment given. This helps keep the taxes low and it makes sense. You pay when you use the medical service, simple. thoughts?

[Guest]

One way of looking at it to think of EMS as a medical service. Just like a doctors visit, ER visit, dentist, etc. All of which you pay by insurance. The taxes off set the money needed to keep things up and running; building costs, ambulances, maintnence, equiptment. The bill is for the service that was provided to the patient with a set cost depending on the treatment given. This helps keep the taxes low and it makes sense. You pay when you use the medical service, simple. thoughts?

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Very well said - made the exact point i was attempting to make. Given that the vast majority of people rarely, if ever, use an ambulance it seems a bit more reasonable that you pay for the service you require when/if you need it. Other than that, everyone pays for the sheer presence of the service and upkeep, etc. It would be great to have everything funded via taxes, but given the every increasing run numbers it would become far too expensive too quickly and up the taxes would go.

[trauma74 111]

I am not sure how things work in Westchester, but I can tell you how things are in Orange County when it comes to billing & taxes for EMS. Within the entire County there are only two VACs that get funded thru a tax district. The rest of us are at the mercy of the Towns and Villages for funding. In my town, the Town Board gives us apprx $190K per year. Our operating budget which includes having paid EMTs during the day is about $375K per year. Being that the Town will not provide us with funding for our entire budget, we have to get the money from somewhere. That is why we started billing. We mainly do third party (soft) billing. If a patient does not have insurance and they cannot afford to pay the bill, we do not pursue them for the money. We send a few letters of request for payment because some patients get a check sent directly to them from the insurance company and they fail to turn that amount of money over to us. This is considered insurance fraud.

Some of the VACs up here do not receive any tax money, so their only source if revenue is from billing. It is kind of sad that in this day and age with the cost of medical supplies and equipment that municipalities do not provide funding to the VACs.

Some of the VACs who provide EMS to non-residents of their Towns will take these patients to collects for non-payment of a bill.

The point I am trying to make is that even though VACs get some tax money, they need this billing money to survive. Until the municipalities start providing more funding to the VACs, they VACs will continue the practice of billing. The members of the public and others in the public safety field might think this is wrong, but for now it is a fact of life. For those who do not agree with billing, I urge you to lobby your town officals to provide more funding for EMS.

[trauma74 111]

I forgot one thing, I would like to comment the billing of MOS's. If an MOS gets injured on or off duty and a bus responds, the MOS's insurance carrier should be billed for the service provided. If the MOS does not have insurance, a bill should not be sent to the MOS. That would be a courtesy to the MOS from the EMS service.

I see no reason why a bill should not be sent to the MOS's insurance carrier. Is the MOS's insurance carrier going to give a refund to the MOS because the EMS service did not send a bill to them? The MOS's insurance carrier will not raise the insurance just because the EMS service came and treated the MOS.

When we started billing back in 2000 we spoke to our local FD and PD. We explained the third party billing to them and we told them that we will bill the workers comp insurance if we transport one of them. The FD Chiefs and Commissioners along with our local PD Chiefs all had no problem with this. We told them that if one of their guys happens to receive a bill either by accident or if the workers comp does not pay the bill, to call one of us and we will take care of it. They all agreed to this.

We also explained to them that when we come to a fire scene to do rehab, we are not going to bill them for being at the scene, for the use of our oxygen, oxygen supplies or any other medical supplies used there. We told them that we would only generate a bill if we transported. They were good with this set up.

Our local fire district gets a million and a half dollars a year from the tax payers. This is way more then EMS gets and we are running double the amount of calls and when we go out on a call we end up transporting 90% of the time. The FD runs less calls and when they get paged out 90% of the time it is for an automatic alarm and they are back in quarters within a short time. We also have paid EMTs during the day. This is not free, so we must try to collect as much money as possible for the services we provide.

[jps385 0]

The issue of billing MOS comes down to medicare regulations. By law medicare must receive the best rate for services provided, so if you don't bill someone (an MOS) the rate is 0. If your agency is in a situation where the perception is that someone is receiving a better rate than medicare this is fraud. While places do get away with this if there is ever an audit it will result in serious possible criminal issues for those in charge on an agency. With the regulatory environemnt in NY changing the likelyhood of an audit is increasing. The best way around this is simple soft billing. You mail the bill and forget about it. If you get something great, if not better luck next time.

[Guest partyrock]

If you are going to bill then bill all people. Trauma74, you mentioned people not turning over their transport reimbursment to the VAC, thats no more insurance fraud than soft billing is.

As for billing MOS. If you are injured on the job workers comp or what ever insurance your employer has will cover it so long as it is documented that the injury or illness is work related. Just for good measure give your employer as your home address. It helps to remind them that its their problem and not yours if the insurance company decides to play games.

[helicopper 1,050]

If you are going to bill then bill all people. Trauma74, you mentioned people not turning over their transport reimbursment to the VAC, thats no more insurance fraud than soft billing is.

As for billing MOS.  If you are injured on the job workers comp or what ever insurance your employer has will cover it so long as it is documented that the injury or illness is work related.  Just for good measure give your employer as your home address.  It helps to remind them that its their problem and not yours if the insurance company decides to play games.

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Thanks Party - you took the words right off my fingertips. Either you bill for service or you do not - there can be no special "consideration" of "MOS" or anyone else for that matter. If you don't bill everyone, you'll get nothing (and like it!). As for pursuing collection, how aggressive to be is your decision but I think insurance requires at least one letter attempting to collect to avoid being in conflict with billing requirements. I wouldn't publicize arrangements whereby anyone can call you to "take care of a bill" - I don't think an insurance company would be to pleased to learn about it!

x635, what about when your tax supported EMS agency responds to and provides service to a non-town resident? Shouldn't they receive a bill? They're not paying for the service via tax subsidies but they're adding to the operating expenses. So, if you're going to bill them - you bill everyone! It may be crummy but that's the insurance industry.

On the flip side, suppose you're a taxpayer in an area where EMS is tax subsidized but when you call for an ambulance they can't respond and you get a mutual aid rig. Can you request a rebate on your taxes since you didn't receive the service you're paying for?

With the penny pinching politicians pulling purse strings - try to say that three times fast!!! - and the miserable insurance reimbursement rates, the need to receive tax $$ and bill insurance companies is an unfortunate reality.

You're right - don't give your home address or phone number. Many records, including medical records can be accessed - especially for legal action - and if you're in law enforcement you don't want the defense attorney to have your home address and phone number when they receive medical records relating to a criminal case!

[Guest partyrock]

Sorry Chris, I thought you flyboys were faster than that? Thats right you probably have a pre-post checklist to go through.

I know I just posted, but this just hit me. First, I almost forgot...there are fire depts out there that do bill for services provided. Especially for hazmat. The big difference between PD/Fire and EMS is the outlaying of resources for each call.

Whats the cost difference between a day with a room and contents fire and a day with your average AFA? The water is paid for wether you use it or not in depts with hydrant use fees and you get your hose and tools back. So you have the cost of some bottled water and diesel fuel. How about for PD? Thier jobs are very cost effective. A cardiac arrest is going to cost hundreds for the drugs/IVs, intubation kits, BVM, defib pads, etc.

Lets also not forget that PD and fire raise money outside taxes. Parking, traffic, and other fines all go into city coffers as do cash seizures, however these often have restrictions on how they can be spent. Fire also pulls in money from code enforcement. I love the idea of fines for smoking, morbidly obese consuming fried food, the list goes on.

Edited March 9, 2007 by partyrock

[Guest]

I was going to say...isn't soft billing illegal?

[Guest alsfirefighter]

Despite paying taxes, which are the price of freedom, most municipalities charge for services and fees above what you pay in taxes as it is. Some like building permits and fees, water fees, some collect extra for garbage pick up and sewer service and so on.

If you want a quality service I believe its difficult without billing unless it is a tax district like fire districts. Which we all know how well districts do equipment wise versus municipalities. Spoiled brats (scammers). lol.

The way taxes would be divided into a budget to provide ems would severely limit that agency from keeping up with technology and equipment advances with tax increases looming over their heads and barely covering overhead costs.

[mfkap 0]

I was going to say...isn't soft billing illegal?

←

From what I learned as we went through the third-party billing process, "soft billing" isn't illegal but third-party billing is. You can't send a bill to the insurance company without sending a bill to the patient (which is what third-party billing is). So all the third-party billing companies send a bill to the patient but take no collections actions against the patient. That is what the soft-billing is: send a bill to the patient without any follow-up or collections.

[Guest partyrock]

huh??? Third party billing is having an outside agency handle the billing. They send the bills to the appropriate people. It is perfectly legal. Secondly, billing only the insurance company and not the patient is not illegal so long as the insurance company covered the entire expense. Soft billing is illegal in that it allows people to recieve the same service at a lower rate than madicaid and private insurance companies pay.

[jps385 0]

huh???  Third party billing is having an outside agency handle the billing.  They send the bills to the appropriate people.  It is perfectly legal.  Secondly, billing only the insurance company and not the patient is not illegal so long as the insurance company covered the entire expense.  Soft billing is illegal in that it allows people to recieve the same service at a lower rate than madicaid  and private insurance companies pay.

←

3rd Party billing is when the insurance company (3rd party) is billed. It is not illegal unto itself, provided no money is received from medicare. However once medicare is billed at a rate which is greater than the rate anyone else receives (and if the patients without insurance receive no bill the effective rate is 0) then crime has been commited. (you can look this up on the CMS website). Soft billing is perfectly legal and actually hard billing for any healthcare (ambulance or otherwise) is currently the focus of congressional oversite as it relates to not-for profit status anf eligibility for fed aid for for profits.

[helicopper 1,050]

From what I learned as we went through the third-party billing process, "soft billing" isn't illegal but third-party billing is.  You can't send a bill to the insurance company without sending a bill to the patient (which is what third-party billing is).  So all the third-party billing companies send a bill to the patient but take no collections actions against the patient.  That is what the soft-billing is:  send a bill to the patient without any follow-up or collections.

←

Third party billing = an insurance company, workers comp, etc. Someone other than the patient.

Soft billing = sending a bill to John Q. Citizen but not following up on it for payment (like using a collection agency).

I think the issue arises if you bill insurance companies but do not send a bill to a patient who has no insurance. That's right Mr. Mayor, we're sorry you don't have any insurance but the law requires that we send you a bill.

I think you're also on very thin ice if you make known that you don't have to pay a bill. It's one thing not to pursue collection but another to say don't worry, Mr. Mayor, you don't have to pay for the $500. ambulance ride you just got. Just remember us at budget time (yeah, right).

If Medicare finds out that you're not billing equally they're going to stop paying you - period! That could be the loss of a lot of revenue.

Keep it on the up and up. Send EVERYONE a bill for the appropriate service(s). Let them figure out for themselves that you don't aggressively pursue collection!

[GAW6 66]

I have done extensive research on this subject. First of all Fire Districts CANNOT bill under State Law. VACs who are Tax Districts can bill only if their governing body, i.e. Town Board, signs and passes a resolution. This is the opinion that I have received from the State Comptroller's office through William Young, esq., who is the attorney for NYS Association of Fire Districts.

On a personal note, I am appalled that there are Tax District VACs out there whose billing companies are calling and harrassing people (residents of their district) for $35 balances!