Loading...
HomeMy WebLinkAboutItem 05 - EMS Patient Account ManagementMEMO TO: FROM: MEETING DATE: SUBJECT: PRESENTATION MEIN I M� or" HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL BRUNO RUMBELOW, CITY MANAGER �� DECEMBER 20, 2005 PRESENTATION BY FIRE DEPARTMENT ON EMS PATIENT ACCOUNT MANAGEMENT Fire Chief Steve Bass will present and discuss the attached information regarding the recommendation to contract with Intermedix, Inc. of Houston for EMS account billing, records management, reporting and analysis. Mr. Jason Mattern, Vice President of Sales for Intermedix will also be present. December 13, 2005 (9:41 AM) EMS PATIENT ACCOUNT MANAGEMENT Intermedix, Inc. EXECUTIVE SUMMARY Nationally and locally the emergency medical services (EMS) delivery system has evolved from a "load 'em and go" service to a primary and critical component of the nation's health care system. Costs, regulations, records management, documentation and reporting requirements have increased for all providers resulting in a cumbersome and extremely complex process which must be managed professionally, efficiently and effectively. Effective management requires technology, adequate staff, training and other support processes be dedicated to this task. Intermedix, Inc. provides a patient account management service geared specifically to serving EMS providers. Utilizing hardware, software and associated technology the service provides medical claims billing, financial analysis, medical records management and medical reporting services which would be cost prohibitive for the City to develop, operate (staff) and maintain. In addition, the service will provide the City a significantly higher percentage and dollar amount of reimbursements while eliminating all direct billing or payment by any resident of Grapevine. Estimated revenue for the first calendar year of service is estimated to be more than $400,000 as compared to approximately $200,000 this year. After the initial "ramp -up" year, it is anticipated that revenue will continue to increase each year and quickly reach $1,000,000 or more within a very few years. Patient Billing and Revenue Patients transported by the Grapevine Fire Department emergency medical services (EMS) have, since the inception of the system, been billed for these services using a flat -rate model. Currently, the fee for transporting a resident of the City is $200. The fee for transporting a non- resident is $300. Additionally, a fee of $15 is added if the patient is administered oxygen. The resulting maximum charge of $215 to $315 is regardless of services, procedures, or supplies provided or for the mileage traveled to the destination hospital. This flat -rate -billing model was the predominate model used by transport ambulance providers, including for profit providers, for many years. The patient's insurance carrier is billed and any unpaid amount is then billed directly to the patient and collection is pursued. If a patient does not have insurance coverage, then he/she is billed directly. The patient is obviously expected to pay the charges. As a result of this system, the City will collect approximately $200,000 this year. As the total health care system has evolved the cost of providing the service has spiraled rapidly upward. As a result, it has become more essential that providers be reimbursed appropriate expenses. One response of health insurance carriers to protect their policyholders and the company has been to develop a schedule of reasonable and customary charges for medical health care services. These charges are the amounts that the insurance carriers have deemed to be reimbursable without challenge and are based on the typical and expected charges for specific medical services, adjusted by region. Using Intermedix, Inc. the insurance carriers will be billed the reasonable and customary charges for all services provided, including transport mileage. These charges are significantly more than the flat -rate system is charging, yet are readily paid by most health insurance carriers. It is our suggestion for the City to accept only the amounts reimbursed by the insurance carriers and dismissing the remainder for those patients who are residents of Grapevine. Additionally, the City may elect to not send any bill at all to uninsured patients. This is the practice recommended for Grapevine residents and allowed for by law for city owned and operated ambulance suppliers. The end result is that residents of Grapevine will not see any bill for EMS services beyond what their insurance will cover for these services. It is required that non-residents (approximately 46% of patients transported) be billed for all unpaid or uninsured portions of their ambulance bill. This system provides a tangible benefit for residents that have supported the system by taxes while non-residents are billed and expected to pay the reasonable and customary charges for services in their entirety. Intermedix handles all billing and collection tasks essentially without involvement by City staff. Records Management and Incident Reporting All incident reporting is done via secure and encrypted internet-based input. This system does not require any added software or hardware by the City and can be accessed from any Internet connected computer; even mobile computers. This requires significantly less time for the paramedic to complete than current server based input and is much more comprehensive and accurate. Medic workload is further reduced as the system automatically faxes a copy of the patient care report to the receiving facility within minutes of the report being completed. All patient care reports, EKGs, patient correspondence, invoices, remittance statements, insurance company payments records and our agency's past and present revenue information are available digitally on-line for immediate review by authorized individuals. This virtually eliminates our need to maintain medical records on our own, significantly reducing paperwork and storage requirements. State Reporting All required epidemiology information, including trauma patient information, is reported directly to the proper agencies utilizing data from the run records. There is no duplication of effort and the reporting burden on the City is totally eliminated. Management Reporting The system provides the City with current, up-to-date reports and statistics, including demographic and patient location reports, response time reports, financial statistics reports, call type reports, individual medic statistics, certification and licensure expiration reports, and many more. All reports can be customized to see exactly the information needed. Additional Features Other services features include toll free patient access, credit card payment options for patients, and training options for City staff Summary of Benefits Significantly reduced paperwork, virtually no involvement in billing and collection issues, better management of financial information, a better grasp of the "big picture" of the organization, and significantly higher revenues. Cost to the City Intermedix charges 12% of revenues collected. POSITIVES AND NEGATIVES OF SERVICE CONCLUSIONS AND RECOMMENDATIONS The services provided by Intermedix, Inc. are of great benefit to the City of Grapevine and to the residents of this City. More revenues will be received; residents will pay less money; paramedics will spend less total call time; more efficient reporting will be accomplished and more efficient records management will be provided. The Fire Department recommends this service be initiated by the City of Grapevine. 3 Substantially increased revenues Charges are higher than present charges Residents no longer receive a bill for service Non-residents expected to pay higher costs Paramedic time on call shortened Higher "write-off" of billables State reporting handled automatically Less direct contact with residents having billing or payment questions Intermedix responsible for all billing, records management, collections and reporting On-line report completion is faster than current Reports available on line All IS functions handled by Intermedix Higher collection percentages and dollars Charges are dynamic with economy and industry No necessity to maintain paper files or digital reports local) CONCLUSIONS AND RECOMMENDATIONS The services provided by Intermedix, Inc. are of great benefit to the City of Grapevine and to the residents of this City. More revenues will be received; residents will pay less money; paramedics will spend less total call time; more efficient reporting will be accomplished and more efficient records management will be provided. The Fire Department recommends this service be initiated by the City of Grapevine. 3 EMS Patient Account Management Service Questions and Answers 1. Who/what is Intermedix, Inc.? Intermedix, Inc. is an advanced patient account management service for EMS providers located in Houston, TX. They provide several services related to EMS account management including billing and records management services. 2. In simple terms, what is Intermedix proposing? Intermedix is proposing to provide billing services for medical services provided by the fire department. Additionally, Intermedix will provide records management in the form of electronic field reporting of patient data, electronic storage and maintenance of all related EMS records, reporting of state required epidemiology statistics and financial, demographic and response statistical information. 3. How is billing for medical services done today? Currently the fire department bills a flat rate of $200.00 per patient for residents of Grapevine and $300.00 per patient for non-residents regardless of care provided. An additional fee of $15.00 is accessed for the use of oxygen. The department bills the patient's insurance carrier. The patient, resident or non-resident, is then responsible for all expenses not paid by the insurance carrier except in the instance of government health insurance programs (Medicare or Medicaid). 4. How is the proposed system different? Billing proposed by Intermedix will be direct to the patient's insurance carrier or government health insurance program. Residents of Grapevine will receive a statement that all charges have been billed to their insurance carrier and that any unpaid portion of the bill will be waived. Residents will only be billed to the extent of their insurance coverage. Non-residents of Grapevine will receive a statement that all charges have been billed to their insurance carrier and that any unpaid portion/deductibles/co- payments will be the responsibility of the patient (again except in the instance of a government health care program that mandates assignments or adjustments). Also, the billing basis will shift from a flat rate system to an itemized "reasonable and customary" charge basis. In this model, charges are based on specific procedures and supplies utilized and are billed at rates that insurance companies are customarily paying. The result is a significantly higher cost recovery by the City. The suggested rate schedule will be supplied to the city for review and approval. 5. How does charging "reasonable and customary" fees differ from what we do now? Reasonable and customary charges allow the department to recover more of the expenses for goods and services provided during the treatment and transportation of patients. These reasonable and customary rates paid by insurance carriers and governmental health programs are adjusted on a periodic basis (usually not more than annually) to account for the rise in health care costs. The City of Grapevine currently bills below what is considered reasonable and customary and below what federal healthcare programs will reimburse for our services. 6. Why is there a desire to change? The current reimbursement fees are significantly less than prevailing rates in other flat - rate based systems. The current billing process generates approximately $200,000 per year. As a result, virtually the entire cost of providing EMS services is born by Grapevine residents in the form of paying EMS charges as well as through taxes. Changing the fee structure and the billing process and thus the amount and percentage of revenues received will reduce the burden on residents, more evenly distribute the cost of providing EMS, and significantly increase cost recovered by the City. 7. Will there be any changes in emergency services provided? Residents will see no difference in emergency health care service. The fire department will still deliver the same dependable, prompt and professional service it always has. 8. How will this change affect our citizens? Residents of Grapevine will no longer receive a bill for any medical services rendered by the fire department beyond what their insurance will cover. 9. How will this change affect our visitors? Currently, 46% of all patients treated and transported by the fire department are non- residents of Grapevine. This proposed change will result in some visitors having to pay a higher rate for the service than they would have previously. They will be billed for the full amount. 10. Will this change affect health insurance rates? Emergency medical services (ambulance) billing represents less than 1 % of all medical expenses in the US. Insurance providers are not likely to increase premiums to offset such a small portion of the medical communities' costs. 11. What collection procedures does Intermedix use? Collections procedures are set by the city and are widely varied from pursuance of all fees to the write-off of all charges not covered by insurance. The fire department's recommendation is that residents not be billed beyond what their insurance carrier pays and that non-residents be billed for unpaid portions. Intermedix will utilize due diligence in seeking collection but will not utilize harassing or inappropriate techniques. Most likely this will entail the mailing of up to three "payment overdue" type notices and then be written off if they are not paid through these attempts. 12. Will service ever be compromised to our citizens because of no insurance or for lack of financial capability? No! 13. Other than financial, what benefits will this service provide to the City and department? (See question 1) 14. How will insurance information be collected from patients? This information will continue to be collected by our Paramedics in the field as well as by Intermedix through normal medical information collection procedures. 15. How much will the service cost the City? The cost to the city will be 12% of collected fees plus an additional fee of 1.8% for the use of credit cards for payment. 16. How are the payments handled? Payments by insurance carriers, government programs and individuals are sent directly to Intermedix and then forwarded weekly to the city for deposit (original checks). All checks are still made payable to the City. The city reimburses Intermedix for the 12% fee after deposit of these collections on a monthly basis. They are only paid based on a percent of what is collected. 2 17. How much additional revenue should this generate? The department and Intermedix estimate that revenues for 2006 will be $400,000.00 ($200,000 increase over 2005). Revenues should continue to increase as outstanding receivables are collected and should peak in about 18 months. Revenues should thereafter increase proportionately with the increase in the number of patients treated and transported 18. Are other cities utilizing this service? The cities of Euless, Bedford, Keller, Richland Hills, Sherman, Bonham, Pantego, Azle, Midlothian, Ferris, Kennedale, Bowie, DFW Airport Public Safety and several other cities in our region have already chosen to contract with Intermedix for their billing services. Coppell and Southlake are in the process of changing ambulance -billing services to Intermedix. Statewide over 120 cities are utilizing the services of Intermedix. 19. Are there any unfavorable references or comments about the service? The users contacted have expressed none. 20. Does the practice of not billing uninsured patients encourage others to not carry health insurance? As the cost of pre -hospital emergency medical services is much less than any of the other services that are billed for in the medical field, it would seem unlikely that persons would chose to not carry health insurance just to avoid paying an ambulance service fee. All people carry health insurance for reasons other than 911 -ambulance usage. Most people never anticipate using an ambulance and therefore get insurance for general physician visits, procedures and potential hospitalizations. 21. Has the City Attorney looked at the contract and proposed service agreement and signed off on them? Yes, both have been approved with changes by the city attorney's office. 22. If records are maintained by Intermedix, how do patients get copies of reports? Intermedix furnishes a toll free number for patients to call and request copies of the report or the patient can contact the fire department and we will request a copy for them.