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Revenue recovery is the process of obtaining financial reimbursement for the cost of providing medically necessary ambulance transportation. Medicaid, Medicare, and most other private insurance policies (health, auto, and/or homeowners) allow for reimbursement for this service. Spotsylvania County has implemented this program to seek reimbursement of these funds that are being reinvested in our fire, rescue, and emergency management system to address the growing needs of our combined system.
County residents who do not have any insurance and qualify for compassionate billing can submit a Compassionate Billing Form (PDF), and fees will be waived. Other county residents can also apply for a waiver to determine if they qualify.
In accordance with the Compassionate Billing Policy (PDF), the county's billing service will attempt to gain all information required to show the medical necessity of the transport. However, if the claim is ultimately rejected, the department will consider the charge uncollectable for county residents.
The Compassionate Billing Policy (PDF) addresses this matter. If this occurs with a non-county resident, it is the intent of the county to bill for those services to seek reimbursement. Again, if residents and non-residents qualify for the Compassionate Billing Waiver (PDF), they can submit the appropriate paperwork.
Several billing vendors advised that this should not occur, as most if not all policies do not have a limit on emergency transports related to EMS service. If this did occur, the locality could decide to waive some or all of the charge for residents based upon the circumstances. Under Spotsylvania's Compassionate Billing Policy (PDF), additional fees would be waived.
Spotsylvania's billing company will not pursue payment recovery through a debt collection agency without the expressed authorization of the County Administrator or his designee.
Regarding the discussion among staff regarding an Office of Inspector General (OIG) opinion that surfaced last year. This opinion relates to the jurisdiction being able to use any taxes (real or personal property) to qualify as the co-pay for county residents. To clarify, the county is utilizing the OIG opinion for its residents, so the out-of-pocket expense for the co-pay will not need to be paid for by county residents.
We know that some residents have expressed concern about some people who cannot afford to pay for this service and/or do not have any form of insurance. Specifically, they feel some people will hesitate in calling for assistance from the EMS crews when they have an emergency. The ability to pay will never be considered when providing service.
Under the Compassionate Billing Policy (PDF), no one will suffer financial hardship as a result of a necessary emergency medical transport. When residents need emergency assistance, they should call 911 without hesitation. Also, based upon the localities we have contacted, they have all reported that there has not been a decrease in call volume but in some cases call volume has increased.
If you or family members are not transported, there will be no bill for services rendered. Revenue recovery is based on what is termed "loaded service", whereby someone is actually transported.
Funds have been and continue to be reinvested into our combination fire, rescue, and emergency services system for countywide improvements per the Spotsylvania County Board of Supervisors' action on April 5, 2005.
Other localities have noticed a slight decrease in donations for an initial period of time. We were told that within a couple of years the donations do return to pre-revenue recovery levels. Some localities have set aside some of the funds generated by the program, and if the volunteer agencies demonstrate there has been a reduction of donations, the locality will make up the difference. Two of the localities surveyed (Chesterfield and Roanoke) have advised that the volunteer agencies have not demonstrated any reduction in donations.
Many automobile insurance policies and homeowners' insurance policies provide some form of coverage if the insured was injured and required transport by ambulance, per information provided to staff by several billing companies. County staff recommends that citizens review their insurance coverage to verify their limits of coverage under each policy. In speaking with the billing contractors, they routinely bill health insurance first, then auto, and lastly any other form of insurance.
Spotsylvania County contracts this service out to a private company to handle the process. After patient care is provided, insurance information will be obtained routinely, often at the hospital. Spotsylvania County will waive co-payments and deductibles for county residents.
Non-insured residents will receive an initial statement from the billing company, while insured residents will receive an explanation of benefits (EOB) from their insurance company. Non-insured residents may apply for the Compassionate Billing Waiver (PDF). (Please refer to the Compassionate Billing Policy (PDF))
Yes, only county residents will have their co-payments and deductibles waived by using the Compassionate Billing Form (PDF).