Budgeting for city ambulance service to be reviewed – Money Perception

Though the Rhinelander Fire Department’s ambulance service had more than $1.14 million worth of charges for calls last year, based on the department’s rates, only $532,228.87 could be billed for those calls because of mandatory adjustments that are subtracted from the bills related to how they are paid, fire chief Terry Williams reported at Tuesday’s city Public Safety Committee meeting.

“Our rate is not accepted by Medicare, Medicaid, by insurance companies,” Williams said. “It’s all negotiated or determined ahead of time…. We lose more than half of what our billing potential is right off the bat.”

At the end of 2016, Williams said the department actually collected $442,460.59.

RFD fire chief Terry Williams

“If you compared that number to the first number of $1.14 million, it would look like we’re doing horrible, and I would agree with you that, yes, that looks absolutely awful,” he said. “However, that’s not what the patients or their insurance companies see as a bill.

“What the patients or insurance companies see as a bill is $532,228. Now when you compare those two numbers (mandatory adjustments to collections), you can see that for 2016 we have a 76 percent collection rate on our ambulance (service). The national average is 60 percent, so we’re doing really, really good, compared to the national average.”

The report Williams presented to the committee indicated 48 percent, or 775 of the total calls in 2016, were billed based on allowable rates for Medicare, followed by private coverage at 30 percent with 476 calls, Medicaid at 14 percent with 212 calls and commercial coverage at 8 percent with 125 calls.

Based on what’s allowed to be charged for Medicare, Williams said a basic life support non-emergency call is only $220.20 out of the fire department’s rate of $725.

“Our mandatory adjustment right off the bat for that call is $500 that we can’t even bill for,” he said.

Williams said the budget for the city’s ambulance service is something he, interim city administrator Keith Kost and finance director Wendi Bixby will have to look at this year.

“I believe there’s a different way to do the budget that more accurately reflects what’s being charged, rather than the pipe dream of $1.1 million,” Williams said.

When asked by committee member Steve Sauer about the city providing ambulance service to nearby townships when covering for Oneida County’s ambulance service, Williams said patients are billed the same as if they would be in the city of Rhinelander, though charges for mileage could be applied in the townships and an extra charge could be added for patients who are not Oneida County residents.

“The subsidy that each township pays to the county’s ambulance (service), Rhinelander Fire Department doesn’t see any of that money,” Williams said. “Matter of fact, the citizens of Rhinelander are still paying that subsidy to (the) Oneida County ambulance (service). We don’t see any of that money.”

Committee chairman Alex Young, who is also an Oneida County Board supervisor, said the city backs up the county “just as if we had a major incident here that would tap out all the staff that we had, we want the county to back us up, too.”

“We send a bill if we go out there in the county, just like we would anybody else, so we get paid,” Young said.

In the event someone wouldn’t pay an ambulance bill, Williams said city is able to work with LifeQuest to go after a person’s income tax refunds.

“We actually pay LifeQuest a higher percentage to do that for us, but if we didn’t do that, we would be out that money altogether,” Williams said. “Getting something is better than nothing, so to speak.”

Williams said LifeQuest would also be able to assist the city in setting up the ambulance service’s budget.

“Right now there’s numbers in the budget where we’re going off the $1.14 million,” he said. “That’s not a realistic number, you know what I mean? We’re automatically taking $700,000 of write-off. We can go by what are mandatory adjustment fees are…. We can get rid of all those extra lines and make the budget easy to understand.”

“We’ll be getting into budgets soon enough and we can talk about that then,” Young said.