How much does your service charge for transports?

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johnrsemt

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The service that I work for only charges ~$250, no mileage; no matter where we transport to: but I work for the Federal Government, so they are not trying to make money.

The State of Utah; allows services to charge different set rates for different type of transports, and supplies used; and the mileage varies for all paved, or off road runs.

Indiana, where I left in June charges differently for ALS and BLS, emergent and non; and $10.25 a mile. But no charges for supplies
 
I dont know very much about 911 transport costs, but non-emergency costs I am intimately familiar with. The actual amount that each company charges is a closely guarded secret. For the most part, Medicare reimburses the same amount, but private insurers may choose to pay the full amount billed....

Actual cost billed can vary enormously. It is based not only on the level of service (ALS/BLS/CCT), but also interventions (everything from O2 to meds, codes, immobilization, or stairchairing, etc.), place and type of pickup and drop-off (different rates if at a hospital v SNF v residence), mileage (patient loaded only), region (rural v urban, or individual regional considerations, like transports on an island, where fuel and supplies might be more expensive, etc.)
The flat fee (that medicare pays) is determined by a formula involving the average amount that provider billed for that particular service the previous year, the prevailing charge in the region in the previous year (75th percentile) by other local providers, a possible adjustment for urban/rural conditions and a possible additional adjustment for inflation.

Okay, enough theory. Below are approximate numbers for my region, non-emergency transport.

A given service may bill $850 base + $25/loaded mile (or part thereof) for BLS, no interventions. Medicare will reimburse approx $435 + $15.50/mile, up to 35 miles. A private insurance company may pay $650-800 + $20/mile. This is certainly great $$ for an ambulance company, depending on how they do their bookkeeping.

Supplies arent billed directly, but services are. Medicare will pay a flat fee for spinal immobilization (if the service uses disposable or reusable equipment), or "wound care/cleaning/bandaging" no matter what supplies or equipment are used. Lastly, Medicare will pay for a patient to be stair-chaired, whether its one stair or 100.

Of course, if Medicare pays, they need MedNec, and that opens up a whole other can of worms. I just wrote a paper about this for one of my classes, and can provide more details if you want (PM me).

Is this just my region? How does it differ nationally? I'd love to hear more from other areas.
DES
 
I just took a class on medical business and I have to say that the Medicare reimbursement unit highly confused me. they don't allow line item billing was my impression so that each service would just get a flat fee no matter what happened? Please correct me if I am wrong and if there is a chart somewhere that has medicare reimbursement rates for EMS services that would be very helpful!

(hmmm, i think EMS Services is redundant, we'll let it stand for now...)
 
WuLabsWuTecH said:
I just took a class on medical business and I have to say that the Medicare reimbursement unit highly confused me. they don't allow line item billing was my impression so that each service would just get a flat fee no matter what happened? Please correct me if I am wrong and if there is a chart somewhere that has medicare reimbursement rates for EMS services that would be very helpful!

(hmmm, i think EMS Services is redundant, we'll let it stand for now...)
Click to expand...

There are very, very few academic journal articles or sources in general that I was able to find that discuss it. Below please see some of the sources I found (I cannot attach the PDFs, and I think its a violation of the license under which I got the articles, but here are the citations for the articles, mostly govt documents)

"Configurations of EMS Systems: A Pilot Study." Annals of Emergency Medicine 52.4 (2008): 453-4.

Poisal, J. A., C. Truffer, et al. (2007). "Health Spending Projections Through 2016: Modest Changes Obscure Part D's Impact." Health Affairs 26.2: w242-253.

United States. Medical Payment Advisory Commission (MedPAC).How Medicare pays for Services: An Overview. Washington DC: MedPAC,

United States. Government Accountability Office (GAO).Ambulance Services: Medicare Payments Can Be Better Targeted to Trips in Less Densely Populated Rural Areas. Washington DC: Government Accountability Office, 2006.

United States. Department of Health and Human Services Office of Investigator General. Medicare Part B Payments for Ambulance Services Rendered to Beneficiaries During Inpatient stays: 2001 through 2003. Washington DC: Department of Health and Human Services, 2006.

United States. Department of Health and Human Services Office of Investigator General. Ambulance Services for Medicare End-Stage Renal Disease Beneficiaries: Payment Practices. Washington DC: Department of Health and Human Services, 1994.

U.S. Renal Data System, USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2008.

Good Luck!
 
I'll have a look at those after exams. I can get them through my library here at school and you are absolutely correct, the licenses allow students to download the pdfs but we cannot post them back anywhere except to other students from the same institution.

Thanks!
 
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