The Carlisle Mosquito Online

Friday, January 16, 2004


Selectmen vote to increase ambulance fees

"It's likely that Carlisle will need to pay a portion of our ambulance receipts to Emerson Hospital for Advanced Life Support (ALS) service," Fire Chief Dave Flannery informed the Board of Selectmen at their January 6 meeting. The assessment of fees is currently under discussion with the hospital administration. Area fire chiefs have been meeting regularly with hospital officials to formulate an acceptable arrangement. There were 33 ALS calls between January and November of 2003. Flannery expects that the charges per call will be somewhere between $200 and $250.

"The average ALS call volume per year is approximately 40," said Flannery. "Therefore, this could impact our ambulance account in the range of $8K to $10K on an annual basis." At the same time, Medicare has announced that it will no longer reimburse ambulance services for the Cardiac Monitor. It also plans to phase out payment for some other ancillary services such as IV, defibrillation, airway, oxygen, and mileage over the next few years.

Based on the recommendation of Coastal Medical Billing, Inc., Carlisle's medical billing agency, Flannery recommended to the Selectmen that ambulance fees be increased as follows for 2004.

The recommended base rate is approximately 20% above the Fully Implemented Fee Schedule Rates for Medicare. Coastal Medical recommends maintaining a reimbursement rate slightly above Medicare's allowable rate and continuing to charge for ancillary services as long as other insurers will pay for these services. Carlisle accepts assignment of Medicare's allowable rate. A Medicare patient's co-pay is 20% of Medicare's allowable rate, not the invoiced rate.

Historically, payment levels for ambulance services depended upon the organization that furnished the services and ambulance service suppliers were paid on a "reasonable charge" basis. On February 27, 2002, a rule was passed that established a set fee schedule for ambulance services under Medicare, replacing the reasonable charge system. The rule provided for a five-year transition period during which payments for Medicare-covered ambulance services would be based upon a blended rate comprised of a fee schedule portion and a reasonable charge for ambulance services.

We are now in the third year of that transition over to full payment based solely on the fee schedule amount. The base rate blending for 2004 will be 60% of the fee schedule and 40% of the old method. Ancillary charges will be paid at 40% of what would have been Medicare's allowable rate for 2004. In 2005, the blend will be 80% of the fee schedule and 20% of the old method.

The Selectmen voted unanimously to increase the ambulance fee rates as recommended by Flannery.

Ambulance fees

2003 2004

Basic Life

Support (BLS) $300.00 $395.00

Oxygen $44.65 $50.00

Airways $106.37 $110.00

Defibrillation $95.65 $110.00

Mileage $10.85 $15.00

2004 The Carlisle Mosquito