n County , Ky EMS Fights to get Medicare Money

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n County EMS fights to get Medicare money

Lebanon Enterprise

LEBANON — The call comes in. A person has stopped breathing and has no pulse.

n County EMS responds. CPR is performed and defibrillators are used to

resuscitate the patient en route to the hospital. As usual, the bill is sent to

the patients' insurance company- in this case Medicare.

" They'll send it back and say that they could have gone by another way, " said

EMS Director a Coyle.

Many EMS services are having that problem statewide. It's a problem that has

left Medicare owing n County EMS $65,000 to $70,000 for unpaid claims.

" They deny (the claim) when it's really a valid service, " Coyle said. " They've

been denying everything. These are people who really need to be transported by

ambulance. "

" They should be accountable to make their payments like anyone else, " said

Judge/Executive Dave Hourigan.

EMS is a high-cost business that relies heavily on payment of Medicare claims.

About 70 percent of n County EMS patients are Medicare patients.

" Most of our runs are Medicare runs, " Hourigan said.

State EMS director Bishop said that ambulance services must receive the

Medicare money.

" (If the claims are not paid) eventually the ambulance service is closed, " he

said.

Bishop said that ambulance services statewide are in a crisis situation.

Also adding to n County's financial burden is that fact that EMS is up 400

runs from this time last year.

No one is certain as to why the claims are not being paid. AdminaStar-Federal,

who pays EMS for their Medicare runs, can automatically deny any claim for 30

days. After that, they must either pay or refuse the claim.

As Coyle said, AdminaStar-Federal is refusing to pay more claims than usual.

This could be due to budgetary concerns, she added.

" They have a budget that they have to work within, " she said. " They are getting

to close to that budget. "

Washington County Judge/Executive Settles says that it may be for financial

gain, because AdminaStar-Federal is given lump sums of money to pay the claims,

which they invest and draw interest from. The longer they have the funds, the

more interest they draw.

" It only stands to reason that they are going to deny as many claims as possible

just from a business standpoint, " Settles said.

The ambulance service in Floyd County, which has struggled since its inception

in 1995, has closed down, partly because of Medicare's non-payment of claims.

Nearly $450,000 worth of unpaid claims may lead Knox County to close its service

in January.

Coyle insists that n County is not in that boat yet.

" As far as the fear of us closing, I don't really think that fiscal court will

want that to happen, " Coyle said.

Coyle acknowledges that if the situation persists, that there may be changes in

store as a result.

However, EMS is not refusing Medicare runs nor are they considering billing

Medicare patients directly as other hard hit counties are considering.

Instead, EMS has turned to fiscal court for help and they have received it.

" They've really had to cover us a lot, " Coyle said.

Fiscal Court budgeted about $65,000 to EMS to help them continue. Normally the

court provides EMS with $25,000 in the budget.

" It has caused us to have to help out, " Hourigan said. " We, of course will make

every attempt to help. There would be no way we could do without the ambulance

service. "

Hourigan said that the court will have to start making budgetary decisions in

order to fund EMS until Medicare pays them.

He said that in the past the court has provided substantial amounts of monies

for recreation and economic development.

" It's probably things like that they would look at first, " Hourigan said. He

added that he hopes that it does not come to that, but since these things are

not obligations for the county they would have to be considered first.

" We have to think about what is most important to the people, " he said.

There may be relief in sight, however.

AdminaStar-Federal has developed a claim review board to handled claims that

ambulance providers feel were denied in error. The previous process required

them to submit the claims for appeal.

" I feel it will be resolved, " Coyle said.

As to how soon the resolution will come, Coyle does not know.

The last time the situation reached a crisis point was in New Jersey and it

lasted for 18 months. Coyle has doubts that ambulance services can hold out that

long.

Hourigan also believes that problem will be resolved, though he is not

optimistic about being paid for all claims.

" I have serious doubts that they will pay us all of what they owe, " he said.