Payment Delays Troubling for N.Y. Agencies

Aug. 25--North country ambulance squad officials are arguing that while their staffs respond quickly to medical emergencies, payments for service from insurance companies has become too slow-moving.

Some squads have waited upwards of 90 days or more to receive payment, while at the same time having to pay staff, order equipment and service vehicles. As a result, some squads are in dire financial straits. The town of Watertown Ambulance, for example, is considering getting a line of credit to ensure its company bills and employees are paid.

"If you lose your job, you pinch your pennies," said David C. Roof, ambulance squad president. "Hopefully it won't affect our employees. It's a tough industry."

The cost of calls for that squad, he said, ranges from about $150 to $1,000 depending on medication given, procedures done and how far the ambulance has to travel to a hospital. Medicare, Medicaid and other insurance plans may pay a portion, or all, of a bill, but when squads have to wait a few months for payment, their ability to continue service is shaken, Mr. Roof said.

What insurance companies don't cover, patients must pick up. Many patients do not pay that remaining balance, as has been the case the past couple of years for Town of Watertown Ambulance Service, which has accumulated more than $24,000 in uncollected funds annually. A $150,000 annual contribution from the town of Watertown helps offset some of the squad's cost, but doesn't cover it all. That contract is set to expire next December.

Roland G. Churchill, executive director of the Thousand Islands Emergency Rescue Service, said the time gap from when service is provided to when Medicare and Medicaid deliver reimbursement changed beginning late last year.

"Being isolated in Northern New York, I don't know if this is a national issue," he said. "We are lying idle, and we can't continue to operate at a loss."

Mr. Churchill said the average TIERS call costs $512, but the average Medicare reimbursement for those calls is $312. Other insurance companies often follow guidelines set by the U.S. Centers for Medicare and Medicaid Services, he said.

Jeffrey L. Hall, regional director of media relations for CMS, said he was unaware of any problems.

"We don't know of any recent changes in ambulance payment policy or coverage. I checked our website and the NGS website, and everything is quiet -- just the routine fee schedule adjustments," he said in an email Friday. "Things have actually been pretty quiet the last year + regarding ambulance coverage and policy."

Mr. Hall said he was unaware of any particular squad complaints about 90-day payments.

"It shouldn't take that long, but you could give us specific claims that took that long to process, we'll certainly look into it," Mr. Hall wrote.

Clean claims should process in 30 days, he said.

The squads remain unconvinced. Gaining support of local elected officials and making the state's congressional delegation aware of the issue may put pressure on CMS to change the reimbursement schedule, Mr. Churchill said.

That issue, on top of the majority of some squads' calls being billed to Medicaid and Medicare, creates a divot in cash flow.

At the Ogdensburg Volunteer Rescue Squad, Medicare and Medicaid recipients account for 56 percent of its calls. Director of Operations Kenneth J. Gardner said that their reimbursement rates, as well as that of private insurers, are down by 5 percent over the past two years. He sees a trend brought on by economic hard times.

"We have no control over what we get," he said.

A trip to a Syracuse hospital costs the squad about $1,000. Medicare/Medicaid reimbursement for that is $300, Mr. Gardner said.

The financial situation has created a "nightmare" for Mark A. Tuttle, director at Lewis County Search and Rescue, Lowville. He said his fear is an ambulance might not be able to get to someone who needs it.

As Lewis County's largest ambulance operation, Mr. Tuttle said, he tries to have an advanced emergency medical technician around the clock to handle Search and Rescue calls and provide backup for the smaller operations that at times have only basic emergency medical technicians available, or no EMTs at all.

Although that agency itself is financially sound now, Mr. Tuttle said, he is trying to work out formal agreements with other squads that would allow Search and Rescue to bill insurance for an advanced life support intercept fee while assisting ones with only basic EMTs available, as it did twice last weekend.

Potsdam Rescue Squad feels the squeeze, too.

"Our reimbursements from Medicaid, Medicare and private insurers are most definitely declining," said Karen Mousaw, the squad's administrative assistant. "About 35 percent of our patients are insured through Medicare and 25 percent have Medicaid."

She said the emergency care environment has changed dramatically throughout the last 58 years, "with a long road of regulations, unfunded mandates and minimum requirements ahead of every emergency service agency."

"Potsdam Rescue has not been immune to these changes and their financial impact," she said. "We rely on contracts with the towns and villages, donations, grants and fundraisers to help close the gap in order to continue providing care to those who need it."

Although ambulance squad officials say donations from community members and proceeds from chicken barbecues and other fundraisers help defray operation costs, shrinking the payment delay time will be highly beneficial.

Times staff writer Steve Virkler and Johnson Newspapers writer Brian Kidwell contributed to this report.

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