Transport billed... To a dead man's family.

[Tigger]

I'm also still trying to figure out what makes a BLS ambulance ride start at $600. Fuel is expensive, but not that much. EMTs are not getting exorbitant salaries. Except for the AED, nothing in a BLS kit is particularly costly (and anyway, it's billed on top of the base rate). The ambulance itself, perhaps? QA/QI processes?

There are hundreds of costs associated with providing ambulance service, most of them having nothing to do with the ambulance itself.

Rates are not just made up. We know how many calls we expect to run. We know how much money we can expect to collect per call. We know what are our operating expenses are. From this it is fairly easy to determine how much we need to charge per call.

 

[RedAirplane]

I was half sarcastic half serious.

I know the numbers don't just come out of nowhere, they just seemed unbelievably high.

 

[escapedcaliFF]

I was half sarcastic half serious.

I know the numbers don't just come out of nowhere, they just seemed unbelievably high.

A $1,000 dollar ambulance ride is a small amount. Each place has maximum they are allowed to charged for services rendered. For example some places might charge $300 bucks just cause the call was at night. Some even charge extra if it's a ALS ambulance even though a BLS was more than enough just cause the ALS wasn't busy. The rates are set by the county/state and trust me ambulance company's will always charge the max under the rates.

 

[RedAirplane]

A $1,000 dollar ambulance ride is a small amount. Each place has maximum they are allowed to charged for services rendered. For example some places might charge $300 bucks just cause the call was at night. Some even charge extra if it's a ALS ambulance even though a BLS was more than enough just cause the ALS wasn't busy. The rates are set by the county/state and trust me ambulance company's will always charge the max under the rates.

...and air ambulances for rural trauma make this seem like petty change...

 

[escapedcaliFF]

...and air ambulances for rural trauma make this seem like petty change...

I know of someone charged $573,000 for air medivac for so yeah.

 

[RedAirplane]

I know of someone charged $573,000 for air medivac for so yeah.

Yikes! The ballpark number I heard was $17,000. When we're into six digits, I'm not sure if I'd want to wake up after that ride. (Kidding)

 

[escapedcaliFF]

Look at Alaska. They run planes up there. For a air medvac from Purdue Bay to a speciliaty trama clinic in Anchorage I would hope I die on the way.

 

[Tigger]

A $1,000 dollar ambulance ride is a small amount. Each place has maximum they are allowed to charged for services rendered. For example some places might charge $300 bucks just cause the call was at night. Some even charge extra if it's a ALS ambulance even though a BLS was more than enough just cause the ALS wasn't busy. The rates are set by the county/state and trust me ambulance company's will always charge the max under the rates.

Billing an ALS rate for a BLS call (even if the paramedic was in back) is fraud in most cases, CMS is pretty clear about that.

 

[escapedcaliFF]

Billing an ALS rate for a BLS call (even if the paramedic was in back) is fraud in most cases, CMS is pretty clear about that.

Look up Liberty ambulance. They have gotten away with it a couple times in their AOR in Kern county Kalifornia. I can think of a couple of cases. FD and Liberty have gotten into over this cause FD thinks it's BLS but once BLS shows they think ALS is needed even though the FD engine paramedic says its BLS. Literally been a pissing match over this and last I checked they cleaned it up and came to an understanding. That's all it was a pissing match not really fraudulent but close.

 

[Ensihoitaja]

Billing an ALS rate for a BLS call (even if the paramedic was in back) is fraud in most cases, CMS is pretty clear about that.

I thought they could bill for the "ALS Assessment" even if it turned out to be a BLS call otherwise. Did that change?

 

[PotatoMedic]

If Als is dispatched initially then yes you can bill als. But if bls calls for an Als assessment then you can only bill the bls rate if bls transports.

 

[escapedcaliFF]

The issue with Liberty is they where sending BLS to calls dispatched as BLS and then they would ask for the ALS. They would show and transport cause Liberty medics decided it was ALS even though it could of gone BLS. It wasn't just some isolated cases of a EMT not being comfortable transporting BLS either. It was a pattern and didn't stop until FD raised concerns.

 

[Ensihoitaja]

If Als is dispatched initially then yes you can bill als. But if bls calls for an Als assessment then you can only bill the bls rate if bls transports.

That makes sense, thanks!

 

[JeffT]

Bill it, but don't expect to get paid. On a side note, something a hospital I used to work for did a lot was bill "patient convenience fee" for any ambulance run where no actual transport was done (usually diabetic, etc.). Discussing it in class no one else had heard of that type of maneuver. Is that type of billing something that is done industry wide or is it just something the penny pinchers at my ol hospital did. Usually insurances did not cover the 'patient convenience fee' so it aggravated the heck out of the folks getting the bills... especially if the patient was not who called 911 and it was someone else that saw them have a low.

 

[escapedcaliFF]

Bill it, but don't expect to get paid. On a side note, something a hospital I used to work for did a lot was bill "patient convenience fee" for any ambulance run where no actual transport was done (usually diabetic, etc.). Discussing it in class no one else had heard of that type of maneuver. Is that type of billing something that is done industry wide or is it just something the penny pinchers at my ol hospital did. Usually insurances did not cover the 'patient convenience fee' so it aggravated the heck out of the folks getting the bills... especially if the patient was not who called 911 and it was someone else that saw them have a low.

Yep seen it done plenty of times. Look up Mesa AZ Fire. They run these things called "community care units". Basically a BLS that fire runs for non 911 calls. Southwest (rural metro) runs 911 BLS and ALS for Mesa but Fire Dept started doing the community care units in partnership with a local hospital. Its kinda a shady deal cause its a money making scem dreamed up by the city FD and backed by the local hospital.

 

[Tigger]

I thought they could bill for the "ALS Assessment" even if it turned out to be a BLS call otherwise. Did that change?

That's still possible but I don't think that changes the base rate of the call from BLS to ALS Level 1.

Bill it, but don't expect to get paid. On a side note, something a hospital I used to work for did a lot was bill "patient convenience fee" for any ambulance run where no actual transport was done (usually diabetic, etc.). Discussing it in class no one else had heard of that type of maneuver. Is that type of billing something that is done industry wide or is it just something the penny pinchers at my ol hospital did. Usually insurances did not cover the 'patient convenience fee' so it aggravated the heck out of the folks getting the bills... especially if the patient was not who called 911 and it was someone else that saw them have a low.

We bill treat and releases where medications are administered (usually D50 and NS). Many insurances reject it, including Medicare and Medicaid. Those two will only pay if the patient is transported.