Finance Department
EMS Ambulance Cost of ServiceAnalysis
November 8, 2010Michelle Mitchell, Director
Table of Contents
I. Background
II. Issues– Collection Rates (2009 vs. 2010)– Cost of Services Receivables Outstanding Billed in the
Last 24 Months
III. Recommendations
IV. Response to Community Concerns
V. Process Improvement Detail
VI. Appendix A – New Ambulance Forms– Transport Information Form– Follow Up Information Form – Invoice– Past Due Notice
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Background
• Houston’s ambulance base transportation rate is the lowest in the state of Texas for major cities at $415. Fort Worth charges $1,146; Austin charges $850 and Dallas charges $800.
• Houston’s cost of service to transport is approximately $1,128 per transport. 90% of all collections currently come from insurance companies.
• Billings and collections are done by ACS, a third party contractor. Currently, ACS receives a fee of 14% of current collections and has an opportunity to earn an additional 6% annually based on productivity targets.
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Issues
• Houston’s cost of service to transport is approximately twice the amount of our current rate.
• Houston is not getting its fair share of available insurance reimbursement dollars.
• Medicare and private insurance reimbursement rates are depressed due to Houston’s low base transportation rate.
• Current process of billings and collections.• Transports billed vs. gross collection:
– 131,000 in 2010 - $68 million billed vs. $24 million collected
– 139,000 in 2009 - $74 million billed vs. $29 million collected
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Collection Rates2009 vs. 2010
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($ In Thousands)
($) % ($) %Medicare 13,324$ 45% 9,080$ 37%Medicaid 6,724 23% 6,307 26%Private Insurance 7,608 26% 6,492 27%Self Pay 3,118 11% 2,754 11%Other (1,129) -4% (278) -1%
Total Collections 29,645$ 40% 24,355$ 36%Total Billings 74,150$ 68,567$ Total Transports 139 131
Collection Type2009 2010
Cost of Services Receivables Outstanding Billed in the Last 24 Months
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Type Original Charge Balance Due Item Count
Billed Insurance 3,584,557$ 2,887,579$ 6,862Billed Medicare 1,102,660 1,057,040 2,101 Deceased Unbillable 3,288 579 6 Duplicate Transport Record Unbillable 18,143 17,463 36 Inability to Pay 185,395 173,951 345 Medicaid 1,439,044 1,335,990 2,722 Nixie 19,996,593 17,842,142 39,235 On Hold Pending Appeal 158,202 153,454 298 Overpayment 1,740,739 (819,751) 3,217 Payment Plan Account Medicaid 5,146 2,775 10 Payment Plan Account Self Pay 284,010 144,408 539 Self Pay 55,964,894 45,462,735 108,207 Workers Comp Claim Medicaid 86,333 79,142 176 Other 14,423 8,555 27
Grand Total 84,583,427$ 68,346,062$ 163,781
* Data as of September 30, 2010
• Increase the base transportation rate from $415 to $1,000.
– The estimated revenue impact from insurance
providers is $5.5 million annually or approximately $3.2
million for FY2011 as of 12/1/10.
• Eliminate the City’s policy of pro-rating charges for multiple
riders in the same ambulance.
– The estimated revenue impact is $500,000 annually.
• Billings and collections process improvement.
• Implement annual fee escalators based on appropriate
indexes.
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Recommendations
Response to Community Concerns
• Implement procedures to identify low income qualifying
individuals at time of transport.
• Implement procedures to allow low income transport
individuals not previously identified to show proof of
qualification at time of billing.
• Implement procedures to bill the uninsured at a discount
rate.
• Implement new intake forms for improved clarity and
readability.
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Process Improvement Detail
• Improve transport identification process for billing.
• Improve the automated hospital sharing information.
• Improve debt collection techniques for transported
individuals (e.g. phone calls, mailings, negotiated
settlements and credit bureau reporting).
• Implement ongoing oversight of the outside billers and
collectors ensuring productivity measure are maximized.
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800-929-6209 Fax: [email protected] Pay by Web: https://www.houstonems-billpay.com
DATE OF SERVICE: BALANCE DUE:
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ACS STATE & LOCAL SOLUTIONS3555 TIMMONS LN STE 680HOUSTON, TX 77027-6459
services you or a family member received on
n Please pay this invoice.n
t Please provide us with your Insurance information.t Please pay your portion (the co-pay amount) of this invoice.
n Billing office: 800-929-6209n Email: [email protected]
Basic Transport FeeBasic Life Support Fee Oxygen & Supplies ECG & SuppliesFluids & SuppliesMisc. SuppliesMileage ($7.50 / Mile)
Total:Insurance MedicareMedicaid
Balance Due:
1. Personal Check/Money Orders: Please make payable to the City of Houston.
2. Credit Card:n By Mail - Please fill-out the information below, and mail in using the enclosed envelope.
VISA Mastercard Discover Card American Express (circle one)
Name on Card
Account Number Expiration Date
Signature
n By Phone - Please call 800-929-6209n On-line at https://www.houstonems-billpay.com
3. You may subscribe to a payment plan consisting of _______ monthly installments of $__________.
You have not responded to the Invoice we sent on for ambulance June 12, 2010
May 12, 2010
Return this portion with your payment and/or insurance information
Why did I receive this
I nvoice?
Retain this portion for your records
If you have Private Insurance, Meidcaid or Medicare not previously provided to us, please do the following:
Incid
entals
Who can I contact if I
have a question?
Invoice Details
What action should I
take?
Insurance company, Medicare, Medicaid or other insurance
provider:
Please
provide this
inf ormation
1/0/1900
CITY OF HOUSTONP.O. BOX 4945
HOUSTON, TEXAS 77210-4945
#REF!
Account Number:
PAST DUE NOTICE POR FAVOR MIRE EL REVERSO PARA ESPAŃOL
Check this box to elect _____ easy monthly installations of $_______ automatically billed to your credit card.
FAILURE TO PAY THIS BILL WILL RESULT IN A REPORT TO A CREDIT BUREAU
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