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Ambulance Cost Recovery (Policy adopted 12/7/2009)
Reasonable fees, reviewed annually, shall be charged for emergency medical transport services provided by the department. The amount of the fees shall be modified when appropriate. The revenue recovery program is intended to pursue reimbursement for EMS ambulance transports by recovering funds that may already be designated for the purpose.
The following definitions shall apply to emergency medical transport charges:
- Basic life support (BLS) is transportation by ground ambulance vehicle and the provision of medically necessary supplies and services, including BLS ambulance services as defined by the state. The ambulance must be staffed by an individual who is qualified in accordance with state and local laws as an emergency medical technician-basic (EMT-Basic). These laws may vary from state to state or within a state. For example, only in some jurisdictions is an EMT-Basic permitted to operate limited equipment onboard the vehicle, assist more qualified personnel in performing assessments and interventions, and establish a peripheral intravenous (IV) line.
- Basic life support (BLS)—Emergency: When medically necessary, the provision of BLS services, as specified above, in the context of an emergency response. An emergency response is one that, at the time the ambulance provider or supplier is called, it responds immediately. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.
- Advanced life support, level 1 (ALS-1) is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including the provision of an ALS assessment or at least one ALS intervention. An advanced life support (ALS) assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient’s reported condition at the time of dispatch was such that only and ALS crew was qualified to perform the assessment. As ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. An advanced life support (ALS) intervention is a procedure that is in accordance with state and local laws, required to be done by and emergency medical technician-intermediate (EMT-Intermediate) or EMT-Paramedic.
- Advanced life support, level 1 (ALS-1)—Emergency: When medically necessary, the provision of ALS-1 services, as specified above, in the context of an emergency response. An emergency response is one that, at the time the ambulance provider or supplier is called, it responds immediately. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.
- Advanced life support, level 2 (ALS-2) is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including: (1) at least three (3) separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids); or (2) ground ambulance transport, medically necessary supplies and services, and the provision of at least one of the ALS-2 procedures listed below:
- Manual defibrillation/cardioversion
- Endotracheal intubation
- Central venous line
- Cardiac pacing
- Chest decompression
- Surgical airway
- Intraosseous line
- Ground transport mile (GTM): Transportation fees shall be assessed per statute mile from the location of the incident scene, or from the center point of the emergency-demand zone, if applicable, where an incident scene or address is located, to a hospital or other facility where a patient is transported.
The schedule of rates for emergency ambulance transport services by Audrain Ambulance District shall be based on a schedule which will be developed and reviewed yearly to maintain compliance within the allowances established by the Center for Medicare and Medicaid Services.
The Audrain Ambulance District is hereby authorized and directed to establish rules and regulations for the administration and collection of the charges imposed by this section.
Fees for emergency medical transport services shall be charges per patient transported for services rendered and transportation provided as initially set and reviewed annually:
- No transport $50.00
- No transport with treatment $100.00
- BLS Non-emergency $350.00
- BLS $500.00
- ALS-1 $650.00
- ALS-2 $1,000.00
Fourteen dollars ($14.00) per GTM. One hundred dollars ($100.00) will be billed to out-of-district patients. (Not billable to insurance)
A bill will be generated for ambulance transports conducted by all ambulances utilized by the Audrain Ambulance District and agencies, vehicles operated or maintained by Audrain Ambulance District. Fees collected will be used by the Audrain Ambulance District to provide emergency services staffing and expenses related to the provision of EMS.
Patients will fall into one of the following categories for billing purposes:
Insured, district resident or non-resident. The appropriate insurance carrier will be billed.
Uninsured non residents: A bill will be sent to the patient transported. If the individual has the ability to pay, then payment is expected in full.
Contractual write-offs. The bills that Medicaid, Medicare, and insurance companies pay on behalf of an insured individual are sometimes adjusted to pay only a portion of the billed amount. This adjustment referred to here as a “contractual write-off” is usually due to the laws governing the payment amount or through agreements between the insurance companies and billing entity. The contractual write-offs are not considered unpaid balances, and will not be billed to patients.
Compassionate Billing Policy
No one will EVER be denied necessary emergency medical transport service due to either their inability to pay or lack of insurance.
All consumers of ambulance services will be asked, in writing, to provide information regarding available insurance coverage. All consumers of ambulance services will receive written notification of the value of services received and notice of billing forwarded to their insurer(s).