EMS Revenue Recovery: An Overview
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 local governments, is seeking ways to fund these services without relying solely on real estate property taxes. Emergency Medical Services (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 program that bills a user fee to Medicaid, Medicare, and private insurance companies for emergency ambulance transport service. A fee is only assessed if a patient is actually transported to the hospital, and if the EMS call does not result in transport, there is no billing incurred.
The most important fact about EMS revenue recovery is that the program will not change the way emergency service is provided. No one will ever be denied emergency service. Billing will not occur until after service has taken place. Even if a patient has an outstanding balance on their insurance, they will not be denied service. In fact, EMS technicians who respond to emergency calls will have no knowledge of who has paid and who has not paid. Individuals covered by private insurance, Medicaid or Medicare will likely be affected very little because most policies have built-in provisions for emergency service. If the patient calls 911 but is not transported, no charge will be made.
Another critical fact about the proposed EMS Revenue Recovery program is that it will include compassionate billing provisions. If an individual can demonstrate financial hardship in accordance with the County’s policy, a substantial reduction will be available.
Revenue recovery has been implemented successfully by more than 40 localities in Virginia to recover necessary funds to support the growing needs of Fire and EMS services. Nearby billing localities include Nelson, Richmond, Chesterfield, Hanover, 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.
If implemented, Albemarle County would 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. Depending on the provider, most insurance companies pay 80% of the charges for service.
The revenue provided by this program 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 County’s citizens. Although the County provides financial support to local volunteer rescue squads in a number of ways - annual funding for basic operating costs such as vehicle fuel, cars, utility vehicles, equipment and disposables; capital funding for equipment and vehicles; and training and volunteer incentives – volunteer squads will still need public support through donations to meet their financial obligations.
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