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Carolina Fire Rescue EMS Journal

WINTER • 2014 3

EMS 2014

The effects of ObamaCare on your EMS service Exploring how the Affordable Care Act will impact our profession By Amar Patel MS, NREMT-P, CFC These days, the word “ObamaCare” is bringing optimism and hope to some Americans and feelings of frustration to a great many others. Many health care providers share these same feelings, and while not everyone agrees on how it should be done, most all would say that medical reform is necessary. There is significant room for improvement in the business of health care. According to Kim Stanley, chief customer officer for EMS Management and Consultants in Winston Salem, N.C., one of the most worrisome unknowns for North Carolina’s EMS community with regards to ObamaCare is the financial impact it will have on transport programs and patient services across the state “Seventeen years ago most volunteer rescue squads did not have the experience or the resources to bill and collect reimbursements from payers, which include Medicare, Medicaid, commercial insurance companies, the VA, hospitals, nursing homes, third party liability (for accidents, etc), or patients if they are uninsured,” explains Stanley.

compliance issues that can easily result in an audit,” says Stanley. “For example, let’s say I own a private ambulance service. While reviewing their reimbursement records, a Medicare representative notice an increase in a certain type of transport my company provides. They decide to do a random sampling of 90 of my transport records during a two-year period. Medicare auditors would review those 90 trips, and if they determine that 45 of those trips were not medically necessary – that the patient could have taken another method of transportation rather than by ambulance – that would be

a 50 percent error rate. They could ask my company for a reimbursement for those trips, but they could also extrapolate the reimbursement for that two-year period of time. That means they could actually ask for 50 percent of all the reimbursements my company received during those two years. If I was reimbursed $2 million, I could be responsible for returning half that amount — $1 million — to Medicare. Even after going through the appeals process, it could easily put my transport service out of business.” Stanley says that as a result of the Affordable Care Act, there are more

EMS Funding and Reimbursements As you know, there are basically four types of EMS programs, and each has different funding sources. • Volunteer EMS squads are frequently funded by donations, and in some cases, local municipalities supplement those programs. Many apply for and receive grants to carry out their mission, and still others bill for their services. These volunteer squads are usually non-profit entities and are staffed by trained volunteers from all walks of life. • County, town and municipalitybased programs employ EMS professionals, both full-and parttime. Ambulances are staffed with paramedics, the highest trained pre-hospital caregiver. Paramedics use advanced skills, medications and procedures to stabilize the patient before they are transported to a hospital emergency department for further care. • There are several counties in North Carolina that contract with hospital-based ambulance services staffed with paramedics to provide EMS services. • Some counties contract with private-for-profit ambulancebased services to handle 911 calls, as well as providing general transport. (Example: nursing home transport for bed-ridden patients to a physician’s office, transport for dialysis, etc.) “For the EMS programs that bill for reimbursement, there are huge

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frequent audits of records in an effort to prevent fraud. In fact, the Department of Health and Human Services (DHHS) has budgeted $300 million to combat Medicare and Medicaid fraud by way of program safeguard contractors, or in layman’s terms, auditors. DHHS says for every dollar they spend on the auditing process, they recover approximately seven dollars in recoupments and refunds. As you can see, it can be a lucrative proposition for them. It can also make life much more difficult for your EMS program. See OBAMACARE page 8

Fire EMS winter 2014  

Carolina Fire Journal Winter 2014 Issue

Fire EMS winter 2014  

Carolina Fire Journal Winter 2014 Issue