Ariola and Kristoff discuss unpaid transports and billing improvements

Okay, so a lot of it relies on a lot of like unpaid transports, billing, and collections.

Let's talk about that.

Approximately 20% of FDNY transport ports go unpaid.

Would that be correct?

There are about 18% of our transports that are self-paid, folks who are uninsured.

And some of those folks do pay, but generally at much lower amounts than our bill rates.

And there would be roughly 10% where FDNY cannot submit a bill at all due to incomplete inpatient information, such as unknown addresses, John and Jane Doe cases, and returned mail.

What steps is the department taking to improve billing documentation and reduce the unbillable share?

So there is regular training that is provided to EMS staff on documentation.

So names and addresses are very important to our follow-up options.

We use an outside billing vendor additionally that can use that patient information to do automatic sweeps against insurance information.

And we share information with hospitals.

So we have agreements with H&H and with Greater New York Hospital Association that allow for sharing of patient insurance information to facilitate our reimbursement.

Okay, so the Medicaid fee-for-service transports that are not billed directly but are reimbursed through the health and hospital subsidy,

how is that reimbursement calculated, and does it cover the full cost of those transports, or does it leave a structural gap that the city absorbs?

So it doesn't fully cover the cost.

That calculation has historically been based on the health and hospital.

hospitals inpatient Medicaid discharge rate.

It sort of harkens back to when we were a part of health and hospitals.

And so it was part of just their general Medicaid reimbursement.

What we were hoping would replace that is CPE, the certified public expenditure process I was referring to.

If that Medicaid state plan amendment gets approved and we can move forward with CPE, it would replace that.

So instead of getting that additional payment through H&H, we would bill directly for Medicaid fee-for-service patients, and then we would get a supplemental payment based on our CPE analysis.

That would come a lot closer to our costs than the current model.

So then if you take into account the rate increase, the unbillable share of transports, Medicaid reimbursement shortfalls, and the cost of EMS operations, do you think that EMS ambulance transport will be a revenue positive

with this new additional cost and fee in place?

No.

So I think ultimately ambulance services are still going to be a net cost to the city.

Even if we were getting reimbursement on every single transport, fundamentally the vast majority of our transports are for Medicaid and Medicare patients, and Medicaid and Medicare pay according to their own fee schedule, not our rates,

and it is generally much lower.

All right, and this is my last question.

Before I'll kick it to my members of the panel, is there any

plan to invest in improved building infrastructure, additional documentation staff, or outreach to uninsured patients?

And what would the return on that investment look like in terms of increased collections?

And has the department modeled that scenario?

So I think the most important piece of this is the documentation that's done by the EMS crew.

It's very difficult for anyone, you know, after that initial incident to replicate that sort of critical basic patient information gathering that needs to happen at that point.

If we have identifying information for the patient and an address, we can follow up.

So, you know, we have insurance database information we can check.

We have those information sharing agreements that I referenced with hospitals that allow us to follow up.

And if we don't get insurance information, we can send a bill to the patient.

The most common call back after receiving a bill is patients calling in to give us their insurance information.

So really it's that first step that is the most critical, which we continue to stress to ambulance crews, that documentation is really important.

The other thing that would really have an impact is changes to Medicaid and Medicare rates that would come closer to covering our costs.

Okay.