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Daytons office holds hearing on Medicare payments for ambulance services

Fri, Jul 13th, 2001
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Who is going to pay this bill?By John TorgrimsonMonday, July 16, 2001

Ambulance providers from throughout Southeastern Minnesota were in Harmony Thursday night to meet with representatives from Sen. Mark Daytons office. They were there to discuss problems with Medicare reimbursements for emergency services that fall far short of actual costs.

Daytons office has been holding hearings in various parts of Minnesota on this issue. Deputy State Director Marc Kimball said that Dayton is fearful that problems with Medicare reimbursement is effecting the level of care ambulances can deliver and that it may increase the response time to emergencies.

Senator Dayton is concerned that if the policies and procedures of the federal government are putting peoples lives at stake, then that is a problem, Kimball told the group.

Brad Hanson, who works on health care issues for Dayton said that this is a state-wide problem, but that rural ambulance services are most in danger.

Gary Wingrove of Gold Cross Ambulance Service, representing the Minnesota Ambulance Association at the meeting, said that there are two issues: the first being Medicare under-paying or denying payment on emergency ambulance services; and, secondly, problems with the pending fee scale that could be implemented later this year.

Wingrove showed figures that highlited the problem. The Minnesota 1998 Average Charge per transport was $685, while the average payment allowed by Medicare was $371. Wingrove said that it is estimated that the national shortfall between Medicare payments and ambulance service costs are $1.4 billion annually.

Many providers, who spoke at the hearing believed that part of the problem has to do with the coding of services and that Wisconsin Physicians Service, the the new contractor that processes claims for the federal government in Minnesota, interprets the codes differently. One person who handles billing from Grand Meadow said that she was told flat out by one claims adjuster that they deny all billing claims on the first application as a matter of course.

Paula Michel of Harmony told the group of her ordeal in dealing with Medicare when her 95 year old mother required ambulance transfer from Harmony Nursing Home to Gundersen Lutheran in LaCrosse. Holding up a sheath of papers that represented nine months of correspondence, Michel talked about an unyielding bureaucracry that continually denied her mothers claims. It was only after Michel made a taped appeal that Medicare relented, paying a little over $300 of the $877.19 bill.

They (Medicare) paid about $2.50 a mile for the 60 mile trip back and forth from the nursing home to Gundersen, Michel said. $2.50 will not cover the costs of keeping up a $100,000 ambulance with supplies. As a taxpayer I am outraged. Who is going to pay this bill?

While noting that underpayments are a serious problem, Wingrove said that outright denial of payment is a more and more common occurrance.

A recent General Accounting Office audit on Medicare reimbursements showed that 11% of all claims are denied nationally, Wingrove said.

There was universal agreement that billing problems are pervasive. Some in the group believe that over-zealous interpretation of the rules and regulations by Western Physicians Services is part of the problem.

One ambulance director spoke about being denied payment on a nursing home patient who fell during the night and had a head lacertion that required treatment, yet, being paid to transport an elderly woman to the hospital who had been constipated for three weeks.

Another spoke about being denied payment on a doctor ordered transport of a potential stroke victim that eventually died.

In the meantime, frustrated patients and their families are being told by the claims processor that the ambulance service submitted the claim incorrectly.

Julie Ziebell, Ambulance Director in Rushford, where the base rate is $300 per trip, likens the process to a Game Show as youre never sure what you are going to get.

Its crazy. Well get $12.90, or $23.00 on a billing for $300. It makes no sense.

Rushford, like ambulance services in many small communities in Filmore County, rely on volunteer emergency personnel, per capita contributions from townships served and a $4,500 grant from the state that is passed through the county.

While the rules and procedures, and the manner in which claims are processed, affects all ambulance providers, rural services are especially vulnerable in areas like Fillmore County where there is an absence of local hospitals. And with over 20% of the population being elderly and more likely to use Medicare, ambulance providers expect a cloudy future.

Jacky Anderson of Chatfield estimates that 75% of their patients are on Medicare and that with the new payment schedule they will lose about half of their annual revenue, going from $90,000 to $47,000.

When asked if Rushfords ambulance service will need city subsidies to operate in the future, Ziebell said, Not yet, but we may have to. It depends on what lies down the road.

Harmony Deputy City Clerk, Eileen Schansberg, who is also a member of the Harmony Ambulance Service, and who helped organize the meeting with Daytons office, seemed to speak for everyone at the meeting when she said that despite the problems with Medicare funding, the quality of care rural ambulance services will provide will continue.

Our people are volunteers from small communities, Schanberg said. They know the people that they are helping and caring for. And for the most part they dont give a darn about the bookwork.

John Torgrimson

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