HomeMy WebLinkAbout12. 15-527
DECEMBER 8, 2015 15-527 RESOLUTION
(CARRIED__7-0______LOST________LAID OVER________WITHDRAWN________)
PURPOSE: APPROVE AMBULANCE RATES AND HARDSHIP POLICY
INITIATED BY: FIRE DEPARTMENT
WHEREAS, the City of Oshkosh has previously established fees for ambulance
service based upon the cost of providing such service; and
WHEREAS, it is necessary to adjust the current fee schedule for the Oshkosh
Fire Department Services; and
WHEREAS, staff and the City’s contracted billing service recommend the
adoption of a hardship policy to provide some financial assistance to those who may
need it in order to facilitate the collection of some portion of the charges for service.
NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of
Oshkosh that the attached ambulance fee schedule is hereby adopted.
BE IT FURTHER RESOLVED that the revised ambulance fee schedule shall be
effective for services rendered on or after 12:01 a.m. on January 1, 2016
BE IT FURTHER RESOLVED that the attached Hardship Policy is hereby
adopted and shall be effective from and after the passage of this Resolution.
TO: Honorable Mayor and Members of the Common Council
FROM: Timothy Franz, Fire Chief
Trena Larseq Finance Director
DATE: December 4, 2015
RE: Proposed Rate Increases for Ambulance Service
The fees for ambulauce service that we chazge aze ceviewed attoually in conjunction with our billing
provider Lifequest Services. This process involves comparing [he cost of services from other
communities and reviewing reimbursement rates from insurance companies. The data this yeaz
indicated that our fees do need to be increased. The rate increase was in 2013. In addition to adjus[ing
our fees, Lifequest has suggested [ha[ we also incorporate a"Hazdship Policy° for collections. A
hardship policy would outline the process for a person with a proven financial hardship situation (fall
within federal poverty guidelines) to receive a discou�ted rate.
ANALYSIS
The fee inc�eases proposed and an[icipated ievenue, were calculated by Lifequest Services. The
individual fees aze listed in the attached table which shows both the current fees and the proposed fees.
I have also i¢cluded [he survey data Ihat Lifequest provided with their analysis, please note the fees in
the survey were based on 2015 ratea Even with [he increases proposed, our base rates will remain
below the avecage of the other providers. We believe the incceases being proposeA meet our budgetary
needs and fall within the prevailing rates for this azea.
Fina�cial hazdship policies are common practice for ambulance providers and are a standazd in [he
healthcare indus�'y in geneial. This policy is not expected to be used extensively, but would provide
some relief to the patients [ha[ "fall between the cracks" of Medicaze and Medicaid Lack of flexibility
in payment negotia[iou often lead to a all or nothing scenazio and often lead to no fees collected.
DiscounGng services have actvally shown to have a posi[ive impact on revenue collectio�s.
FINANCIAL IMPACT
We are conservatively estimating an increase in gcoss fees chazged of $98,989.00 for 2016 if these rates
ere implemented. Actual fees collected are impacted by maudatory Medicaze aud Medicaid write offs,
which i[ should be no[ed [hat we aze anticipating a 0.5 % decrease in the Medicare reimbursement �ate
next yeaz. The impact of the hardship policy should have a positive effec[ on acmal fees collected, as it
will facilitate the collection of at least a poRion of a fee [hat would otherwise go completely
uncollectible.
We cecommend [hat ambulance fee changes in the attached table and Ihe attached Financial Hardship
Policy be approved and implemented by January l, 2016. The increase in ambulance fees is warranred
by the increase in cost of deliveting service and is within the prevailing fees for services in this region.
The hardship policy is in line with other medical and ambulance service providers and will aid the
patients with true financial difficulties [hat fal] ou[ of other programs to pay part of their debt and avoid
being put into the collectio�s process .Please direct any questions on Ihis matter to Chief Franz or
finance Direc[or Trena Larson..
Resputfulty Submitted,
.�ivh�7t�/ ��
Timothy R Franz
Fire Chief
�O�,G �O.x,°cY-�
Trena Larson
Finance Director
Approved:
��,-��
City Manager
Mazk Rohloff
PROPOSED CITY OF OSHKOSH FIRE DEPARTMENT
AMBULANCE SERVICE RATES
To Be Effective 1-1-16
ITEM ITEM DESCRIPTION CURRENT PROPOSED
NO. CHARGE CHARGE
1 BLS Resident 550.00 600.00
2 BLS Non Resident 650.00 700.00
3 ALS Emergency Resident 650.00 675.00
4 ALS Emergency Non-Resident 750.00 800.00
5 ALS Level II Resident 700.00 750.00
6 ALS Level II Non-Resident 800.00 850.00
7 Mileage 15.00 / Mile 15.00/Mile
8 ALS Treat No Transport Resident 80 250
9 ALS Treat No Transport Non-Res. 550 550.00
10 BLS On Scene Care 80 90
11 Urgent Care 90.00 100.00
12 Extrication 300.00 300.00
13 Oxygen Administration 55.00 60
14 Spinal Immobilization 125.00 125.00
1. Rate recommendations are based on cost to provide service, national averages and
trends.
2. All medications and supplies charged at cost plus a minimum of 100%.
City of Oshkosh
Ambulance Billing Financial Hardship Policy
Purpose:
To establish a policy that allows the modifyi�g of ambula�ce fees by the Ciry of Oshkosh's
contracted billing agency (Lifequest Services) based on wrzen[ yeaz federal poverty guidelines,
and to abide by the decisions made by the Center for Medicaid Services.
The City of Oshkosh has established this policy in an order to maintain consistency in assis[ing
uninsured and indigen[ patients who request a reduction or waiver of ceRain ambulance chazges
and/or copayment amounts.
No one will ever be denied necessary medical treatment and transport services due ro either
their inability to pay or lack of insurance.
PROCEllURES:
1. Lifeques[ will address cases of financial hazdship on an individual basis.
2. Patients who are unable to pay their co-pays, ded�etibles, aze uninsured, unemployed,
homeless, or for other reasons unable [o make payments may request a financial hardship
review of their ambulance service charge.
3. Patie�ts or thei� designee will lill out the "Hazdship Application Ve�ification worksheeY'
and �etum it to Lifequest foc review and verification.
4. Lifeques[ wi11 review and verify the information submi[[ed and forward a
recommendation for modification of the bill or denial of the request to [he City of
Oshkosh.
5. The recommendation shall be reviewed by the Finance Director and Fire Chief.
6. Applieants will receive a ootification lettec outlining whether or not the application has
bee� approved or rejec[ed. If an applicanYs cequest for waiver of the chazges is �ejeeted,
Lifequest will provide [he applicaut with a writte� summary and explanation of the
decision.
7. Any denial of"fi�ancial hazdship" discount request will be written and will indude
instructions for reconsideration. if additional documen[a[ion of fivancia] need is received
to support application, the request will be reviewed and considered per the above
guidelines.
8. Bills mee[ing [he following criteria would no[ be considered for financial hardship:
a. Any awount [ha[ is in li[iga[ion
b. Non medically necessary services
c. Auto accidents or Workmads Comp cases pending settlements
d. Any awoun[ where Ihe patien[ received funds direcNy from [heir insurance.
Financial Hardship Criteria:
Lifequest will take into account a range of factors when deciding whether the full payment of the
ambulance charges wil] cause the applicant financial hazdship. In making the deeision whether to
modify the fee, Lifequest will compare the amount eamed by the applicant or within the
applican['s hoosehold with living expenses, assets and debts. W�itten verification, when
available, may be required to subs[antiate and veriCy information contained in [he financial
hazdship application.
Lifequest will use a combi�a[ion of the current year's federal pwerty guidelines to help in
determining if an applicant qualifies for a financial hazdship waivec In applying [hese
guidelines, Lifequest will also consider and take into account any othe� income and expenses
induding money eamed in the entire household. Income and employment status verification may
be required. Documents that may be ceques[ed include: tax re[urns, check stubs and any other
peRinent financial documen[s.
Listed below aze the components which are considered in evaluating in a Financial Hardship:
1. Whether paymen[ of the ambulance charges will affect the applicanYs ability to pay for
the following living expenses:
• food a�d clothes;
• rent or mortgage payments;
• any other basic needs; or
• any special needs (fo� a serious illness or disabiliry)
2. Whethec the applicant owns any assets, such as a caz or house. Assets also iuclude:
• investments;
• money in the bank;
• cash on hand for short term expenses; and
• Money designated for specia] needs.
3. The applicanYs oc applicant household's existing debts.