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Ambulance service makes turn-around on billing

Improves revenue it receives from patients

Ambulance service makes turn-around on billing

Ambulance service makes turn-around on billing

Public Safety Director Ted Wynn


Two years after an alarming slump in payments, the Bulloch County Emergency Medical Service has improved the revenue it receives from patient billing. So for now, at least, the county government is keeping the billing in-house.

In 2008, the EMS collected almost $1.48 million from patient accounts; in 2009, about $1.67 million; in 2010, slightly more than $1.3 million.

But in 2011, EMS collected just $753,197, prompting the county to contract EMS Consultants, based in LaGrange, to do catch-up billing for several months. As a result, more than $2.09 million was recovered from current and past-due accounts in 2012. More recently, the EMS has been improving the billing done by its office staff.

EMS Director Doug Vickers and Public Safety Director Ted Wynn spoke to the county commissioners Thursday evening with an appeal to keep the billing in-house rather than contracting it out long-term to a company such as EMS Consultants.

“I feel keeping billing internal is our best course of action at this time, and there’s a couple of accomplishments that help me say that with confidence,” Wynn said. “Currently, the billing department is caught up and they’ve been that way for the past 90 days.”

Additionally, the county has exceeded a benchmark, which EMS Consultants had identified, of averaging $325 to $350 collected per ambulance ride. With collections averaging $172,000 per month for the last three months, Bulloch County’s EMS billing clerks have also exceeded a monthly $150,000 benchmark, Vickers said.

In the most recent six months, the EMS collected a total of $891,845, suggesting that the total will approach $1.8 million for the 2013-14 fiscal year, which ends June 30.

The current EMS budget is $2.15 million. So, subtracting the bills paid by patients, Wynn observed that the service should cost the general fund – money from property taxes – about $300,000 to $400,000 at this rate.

This is a bargain, he said, for 24/7 ambulance coverage with advanced life support capability. Bulloch EMS has 25 full-time and 24 part-time employees and maintains nine fully stocked ambulances, staffing four of them 24 hours a day.

Vickers started as EMS director 16 months ago, and changes in billing practices have been made under his tenure.

Not just the billing clerks, but everyone involved in responding to calls, from the 911 center to EMS dispatchers, ambulance crews and supervisors, is now enlisted in the reporting needed for timely and accurate billing, Vickers said.

“Everybody’s doing their part,” he said. “Everybody’s working together.”

Previously uncertified, the three billing clerks have now become certified ambulance coders. For this, they received training in “coding,” or assigning claims to appropriate billing categories, plus confidentiality requirements, ethics, regulations for programs such as Medicare and Medicaid, and following up on accounts.

The EMS, Vickers added, will hold monthly meetings with county officials to identify “red flags” about collections and respond to them.

No collections policy

One thing lacking in the in-house billing process is an actual county policy on how to pursue delinquent accounts. The EMS has no late fees or penalties and does not turn people over to a collection agency.

“This is an area where we need your help,” Vickers told the commissioners. “We currently do not have a collection program. We have the software. We don’t have the guidelines. Guidelines have to be set by you. Once they’re in place, they have to be followed 100 percent.”

Advantages of keeping the service in-house, Vickers said, include maintaining control, having local employees to answer people’s questions, and the easy access of a local billing department.

While acknowledging that the EMS has made a turn-around in billing, County Manager Tom Couch said he has seen improvements before followed by some backsliding.

“We’ve seen a very good 180 in what’s been done, but every three or four years, it seems, since I’ve been here, there’s always that tendency to fall off the wagon a little bit,” Couch said.

But he added that he believes the progress can be maintained “with the right policy framework.” One challenge, he said, will be establishing thresholds for turning people who could pay but fail to do so over to a collection process while sparing those who are indigent.

Special event fees

Couch also suggested that fees for providing ambulances at special events may need to be increased.

Currently, the fee for a basic emergency ambulance call is $450, plus mileage charges.

Meanwhile, the EMS charges a $100 flat fee to station an ambulance at a high school sports event. For Georgia Southern University sports, the charge is $180 per vehicle for three hours, plus $100 for each additional hour. For other special events, the charge is $400, plus the $100 per hour after three hours, Vickers explained in an interview.

“I’m not saying we want to go out there and gouge them on that fee, but I think we ought to get a fair cost recovery because, generally speaking, when we cover special events with EMS we’re paying overtime, and we’re taking an ambulance off the street,” Couch said.

Commissioners did not vote on the EMS billing issue. No motion was needed to continue the current practice, Couch said. But several commissioners spoke for keeping the billing in-house.

“I’ve never been a fan of outsourcing. I think outsourcing has kind of hurt America,” said Commissioner Anthony Simmons. “But this goes to show that we have people that are working for us who can beat anybody else doing what they do.”

Al Hackle may be reached at (912) 489-9454.

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