AG 1995 01 17 - Laserfiche WebLink

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Cabarrus County Board of Commissioners January 10, 1995 Page Two This is not an isolated case for Cabarrus County but is happening all across the state of North Carolina to all EMS providers. Under the new guidelines, some Counties, like Anson, will now be receiving less than $30 in reimbursement on an ALS Medicare claim. The NCAEMSA is continuing to fight this current battle with CIGNA. For now, we must establish rates effective January 1, 1995 to coincide with new Medicare codes for all ambulance reports so fraud will never be an issue. Since it takes 12 - 18 months to establish "customary charges" for Medicare purposes, we have no choice but to accept the loses that will result from these Medicare changes for calendar year 1995. By implementing the new charges effective January 1, 1995, we reduce this time frame to 12 months and establish these customary charges in case CIGNA decides to reevaluate in mid year. In the current Fiscal Year 94/95 through December 31, 1994, EMS has collected $310,166.80 in charges for ambulance services. This is broken down in the following manner: Medicare $101,736.41 32.80% Medicaid $23,118.49 7.45% Other $185,311.90 59.75% A total 2,057 Medicare forms were processed during this period of time. As the new regulations are now in effect, we will see a decrease in our collection from Medicare/Medicaid this Fiscal year. The monetary impact is great. Cabarrus County rates and Medicare reimbursement have always been much lower than the State average. For example, for an ALS Cardiac Arrest call in Cabarrus County, the patient would be charged $185 for that service. The Medicare reimbursement for that call would be 80% of the approved $163.64. The average reimbursement for the same call in North Carolina is $211.02. On a non-emergency Medicare transport, for which Cabarrus County charged $185, reimbursement from Medicare is 80% of $105.58 with a state average of $153.49. Because of our low rates, we are receiving at least $50 less per call based on prevailing rates among providers in North Carolina. Cabarrus County rates have always been much lower than surrounding Counties. We have always tried to provide good quality care for a reasonable user fee and this has hurt our Medicare reimbursement greatly. The charges recommended on the attached sheet probably are still not as high as they should be, but in order to continue to provide services at a reasonable rate, and to recoup much of our loses from Medicare reimbursement in the future, I feel they are fair.