ALS/BLS billing agreements

[pamedic983]

I'm new to this forum and came across it on my quest for more knowledge about billing and billings agreements between ALS and BLS agencies. I currently work for the only ALS provider in a rural Pennsylvania county. We work in a tiered EMS system where the closest (usually volunteer) BLS crew is dispatched along with us. They generally load the patient and head towards us/hospital and we rendezvous in en route. The problem arises when we work with a BLS company that does not have a billing agreement with us and the patient ends up with two bills for one ambulance transport and medicare only pays one. There are other BLS companies that we work with that do have agreements with and everything works out great. The staff on both our trucks and the BLS trucks get along no problem and we work fine together to do what's best for the patient.

Is there a norm out there for billing agreements? Are people using flat rates, percentages, etc.?? What works best?? I just feel that it is keeping the best interest of the patient in mind when you come to a compromise to ensure that the patient is only sent one bill that will be covered by whatever insurance they have. Am I wrong?

 

[BossyCow]

We had a similar issue. As a vollie BLS agency, we had no system for billing. When we called ALS if ALS transported in their rig, they billed, but they were unable to bill Medicare for an ALS pt they did not transport. So if they rendezvous with us and the pt is too unstable to transfer to their rig, they would send our agency a bill and we'd have to pay it. We were bleeding out funds with no way to replace them.

We have set up a third party payer system. We get billed from ALS, we bill for the pt, but by our bylaws, only for insurance or medicare. We do not bill the pt directly for any fees unpaid by either insurance or medicare. The monies rec'd from the insurance or MC are used to pay the ALS agency for their time.

This is how it works if we use the local private ambulance company. But they have drastically reduced their workforce and are often unavailable. In that case, we use a mutual aid with an adjoining district. But there are some issues regarding the 'mutual'ity of the exchange since we are only BLS. I haven't seen the bills yet from that agency but I'm hearing rumors that there will be bills.

 

[pamedic983]

Differences

In our system, we are billing the patients even though we are rarely transporting them. Our ALS used to be run by chase trucks out of the rural community hospital and they boarded the BLS trucks with their gear and rode in. Now, even though my company has left the hospital, we are running transport capable trucks and continue to board the BLS truck, ride in with the patient, and bill for ALS services.

My concern stems from the few patients that have gotten wind of the difference in services and have realized that if they request BLS only, they only receive one bill that medicare/insurance pays even when they are in need of ALS care for serious emergencies. The other concern is when you have BLS crews that load the patient and run towards a city hospital and request an ALS truck out of the city that they do have an agreement with.

 

[BossyCow]

No matter what system you come up with the frequent fliers will ferret out the loopholes and use them to their advantage. It's what they do!