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Audit of emergency medical services shows low error rate for Medicare billing

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By Sandy Barnes

The results of an audit of EMS claims that Medicare pays to Evergreen Fire/Rescue has revealed efficiency in dispatch and billing practices for the department.

"We are on the right track and doing what is right, and are trying hard to be compliant," Bob Walter, EMS coordinator, said during his report to the Evergreen Fire Protection District board on Aug. 13. 

"The biggest thing to note was the (billing) error rate was 2.9 percent," Walter said. 

This Evergreen EMS error rate is well below the national standard of 5 percent, he noted.

Funding for the audit, which cost $23,500, was taken from this year's budget for the EMS department.

Walter said he believed the audit was advisable to ensure that the EMS department was handling Medicare calls and billing correctly.

"You need to be worried about the money you keep," said Walter. "We dispatch ourselves and are scrutinized more closely."

Evergreen EMS runs all calls as advanced life support, rather than basic life support, Walter said. 

The accounting firm of Page, Wolfberg and Wirth, specialists in Medicare billing, reviewed 35 of 277 Medicare claims from the EMS department, including patient care reports, accounting transactions and record keeping, and proof of payment.

"PWW detected no major issues, risks or flaws that would cause significant Medicare compliance concerns," the audit report stated.

EMS dispatch services were also reviewed by the auditors, who determined that the state-of-the-art equipment and facilities are functioning at a high level.

The auditors also examined Medicare calls in terms of whether it was reasonable for the patient to be transported by ambulance, and showed that changes the Evergreen EMS made in 2010 to its practices were on track, said Walter.

While discussing his department's collection rates for EMS services, Walter said that Medicare and Medicaid pay a set amount, which is a fraction of the cost. Patients are federally protected from paying more than Medicare reimburses the EMS department, he noted.

"If we bill Medicare or Medicaid, that's what we get," Walter said. "We balance-bill for everything except Medicare and Medicaid.

The average cost of an EMS call is $1,500, Walter said. Medicare reimburses the department about 34 percent of this amount. The percentage of reimbursement by Medicaid is about 7 percent, he said.

"People are shocked when they learn how much we don't collect," Walter remarked.

Regarding collections, another issue is that people who are insured by Blue Cross Blue Shield are paid directly, Walter said. 

The department collection rate is approximately 90 percent, he noted.

"When is the last time we raised the fee?" asked fire board member Valeri Leswing.

"Two years ago," replied Walter.

"A community focus group supported raising fees," said board member George Kling.

"We don't know how much of the billing is the maximum of what we can get paid," said Leswing, who is a pediatric physician.

"Ambulance services and hospitals are different from private practices," said Walter.

Leswing also said the EMS department needs to have a review process in place to check for accurate coding and billing on statements.

"We will start doing random, internal audits," said Walter. "The auditor pointed out we should do a system of checks and balances."

Sylvia Ross, EFR office manager, handles EMS billing, for which she is certified, said Walter.

"I am really happy with the EMS audit," said Leswing.

Firefighter academy begins

Evergreen Fire Chief Mike Weege said 19 applicants had been accepted as firefighters for the district.

The training academy for them was scheduled to begin Aug. 19, he said. 

The roof of the fire training facility at Fire Station 2 has been painted, and minor adjustments to the new building are being completed, Weege added.

The fire chief also said he is developing a 10-year strategic plan for the fire district using data that volunteer Pete Anderson is generating on response times. Anderson formerly developed statistical data for West Metro Fire Rescue while employed with that agency.

A focus group of 22 district residents also is being formed to get input on the plan, Weege said.

"We're going to put together some survey questions," he noted.

Contact Sandy Barnes at sandy@evergreenco.com or call 303-350-1042.