Emergency Medical Services (EMS) Revenue Recovery
Frequently Asked Questions
Q: What is EMS Revenue Recovery?
A: Revenue recovery is the process of obtaining financial reimbursement for the cost of
providing medically necessary ambulance transportation. Medicaid, Medicare and most other
private insurance policies (health, auto and/or homeowners) already allow for reimbursement
for this service. The method has been implemented successfully by more than 40 localities
in Virginia to recover necessary funds to support the growing needs of EMS services.
Q: Why is Albemarle County considering EMS revenue recovery?
A: Emergency medical calls are a large portion of the overall emergency service calls in the
County. As the need for emergency medical service continues to grow, the County, like many
ocal governments, is seeking ways to fund these services without relying solely on real estate
property taxes. EMS revenue recovery permits localities to recoup system costs from those
individuals who benefit directly from EMS delivery, including many non-County residents. EMS
revenue recovery is a type of user fee that raises money needed to operate our system from
the people who receive direct service, with the vast majority of the revenues collected from Medicare,
Medicaid and insurance companies.
Q: How will this program affect me?
A: The program will not change the way emergency service is provided. No one will ever be denied emergency service because of the EMS Revenue Recovery Program. If you have private insurance or are covered by Medicaid or Medicare, it will probably affect you very little because most policies have built-in provisions for emergency service. If the patient calls 911 but is not transported, there is no charge.
Q: How much money will be recovered?
A: Albemarle County estimates that about $1.6 million will be recovered annually once the program is up and running with all career and volunteer rescue squads participating. Those funds will be used to support and strengthen the Countyís combination volunteer-career system.
Q: What other localities in this area have revenue recovery programs?
A: More than 40 cities, counties, and towns in Virginia currently bill for emergency ambulance transport to recover revenue. Nearby billing localities include Richmond, Chesterfield, Hanover, Nelson, Orange, Petersburg, Colonial Heights, and Hopewell. Nearly 80% of Virginia residents live in localities that bill for EMS transport. Nationally, that percentage approaches 85%. Many other localities in Virginia are currently considering this type of revenue recovery.
How the Billing Works:
Q: How will the billing work?
A: Albemarle County will contract with a service to handle EMS billing. Once at the hospital, the patient will provide the necessary information and a claim form will be forwarded to their insurance provider, Medicare, or Medicaid. Patients, themselves, will not be billed until all insurance options are exhausted.
Q: What are the billing rates for this EMS service?
A: The exact rates are not finalized at this time. As a comparison, Hanover County rates are between $350 and $575 depending on the level of EMS care required by the patient.
Q: Will insurance generally pay my entire bill?
A: Depending on your provider, most insurance companies pay 80% of the charges for service. The billing company will accept cash, personal checks, and money orders (no credit cards).
Q: If EMS comes to my house but I donít need transport, will I receive a bill?
Ability to Pay:
Q: What if I donít have insurance and am unable to pay?
A: All patients will be treated and transported regardless of the ability to pay. Albemarleís EMS revenue recovery policy will include compassionate billing provisions. If you can demonstrate financial hardship in accordance with the Countyís policy, a substantial reduction is available.
Q: If I have an outstanding balance on my insurance, will I be refused ambulance service?
A: All patients will be treated and transported. This program will not change the ambulance service provided to anyone in Albemarle County, regardless of insurance coverage or any other factor. Albemarle County will not deny service to those with delinquent accounts. Billing will not occur until after service has taken place. Emergency responders who respond to your call will have no knowledge of who has paid and who has not paid.
Q: Will my health insurance premiums increase as a result of this billing?
A: Unfortunately, health insurance premiums continue to rise regardless of whether or not a community decides to bill for EMS transports. Such factors as prescription drug coverage and litigation have resulted in escalating health insurance premium costs. However, ambulance transport costs represent less than 1% of health care expenditures. Many other local governments in Virginia have implemented a revenue recovery program, and they have reported no evidence that EMS billing increases health insurance premiums.
Effects on the Volunteers:
Q: How does this new program help the volunteers?
A: New funding made available through revenue recovery will be used to offset the rising costs associated with supporting our rescue squads and other EMS service providers, helping them to continue providing the best possible service to the Countyís citizens.
Q: What support does Albemarle County provide to the volunteers?
A: The County provides funding for many of the basic operating costs, such as vehicle fuel, cars, utility vehicles, equipment and disposables; capital funding for equipment and vehicles; and training and volunteer incentives.
Q: Will the volunteer rescue squads still need our donations?
A: Yes. The cost of providing EMS services continues to rise and our volunteer EMS agencies will still need the publicís support.
Q: Will billing impact the donations and fund drives for volunteer EMS agencies?
A: Most agencies and billing companies alike who have researched this issue have found that billing for services has little or no impact on annual fund drive and donation collections.
Q: When will the ambulance fees take effect?
A: We project that billing will begin October 1, 2008.
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