Fire district working to recover ambulance costs

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Patients receive information up front on responsibility for bill

By Beth Potter

Since the beginning of the year, paramedics at the Evergreen Fire Protection District have required patients to sign a waiver of liability before they take an ambulance ride.

The waiver of liability — officially called an "advance beneficiary notice," or ABN, for Medicare purposes — lets patients know they’re responsible for paying the ambulance bill if their insurance company won't.

Officials also have discussed asking patients for credit card information, said Bob Walters, EMS coordinator for the district. They have informally decided against that payment measure.

“We want to make them aware up front: This isn’t free. It’s expensive, and you may have to pay out of pocket,” Walters said.

Anecdotally, getting patients to sign the waiver requirement appears to be helping the ambulance service recover more costs. A couple dozen patients have decided to find a cheaper way to the hospital when asked to sign the waiver, Walters said. No statistics are available yet about how much money potentially has been saved, because of the short amount of time the new requirement has been in place, he said.

“I think it should help,” Walters said of the new waiver requirement. “Hopefully, we’ll get more money.”

The ambulance service has operated in the red for the last decade — usually to the tune of $300,000 to $400,000 per year, Walters said. The EFPD board is expected to write off more than $400,000 in old debt as part of its regular audit process this year.

In addition, ambulance service officials switched to state of Colorado bill collection services from a private bill collector about a year ago. The switch also has meant increased collections and decreased costs, Walters said. While specific numbers are not available yet, state of Colorado bill collection services are free to the fire protection district, while the private company took a percentage of the fees collected, Walters said.

Also on the plus side, the ambulance service now charges patients $150 for any call, even if it doesn’t end up with a trip in an ambulance. The amount was decided on through a focus group process, Walters said.

On the minus side, reimbursements to the ambulance service from Medicare and Medicaid have declined 8 percent this year from last year after the federal Affordable Care Act was in place. The health-care reform act, commonly known as Obamacare, was passed by Congress in 2010.

Medicare now reimburses ambulance services for patients at about 34 percent of a total bill. Medicaid reimburses ambulance services at 7 percent, Walters said.

“The only way we can generate revenue is by billing for service,” Walters said. “There’s nowhere (else) to make that up.”

The insurance reimbursement pinch is being felt around the country, with more ambulance services requiring patient credit cards before transport, Walters said. The ambulance service will not turn away anyone who needs help, he said. Summit County is one where patients are asked for credit cards, according to county officials.

Residents’ property-tax dollars are used to pay for ambulance crew readiness 24 hours a day, seven days a week, Walters said. The ambulance service has 12 paramedics on staff — two paramedics go on each call.

A trip in an ambulance to a hospital — usually in Denver — costs $895 plus $20 per mile, or about $1,500, Walters said.

The ambulance service also can charge a “standby fee” of $85 per hour, which is often used to bill groups for special events such as races or other indoor or outdoor events.