Question # 21: Can you provide the revenue impact of increasing ambulance transport fees to the level originally proposed in the City Manager’s FY 2021 Pre-COVID Operating Budget?

Page updated on Mar 18, 2021 at 5:56 PM

Question:

Can you provide the revenue impact of increasing ambulance transport fees to the level originally proposed in the City Manager’s FY 2021 Pre-COVID Operating Budget?  (Mayor Wilson)


Response:

The FY 2021 proposed budget included increasing ambulance billing fees by 20 percent for all call types to offset more of the cost of providing EMS services. These fees were last increased in 2016. At the time, this proposal was projected to add $200,000 in revenue. The proposal was removed from the proposed budget 2.0 revised due to the COVID-19 pandemic.

To date in FY 2021, the Fire Department is still seeing ambulance transports down approximately 10 percent from pre-COVID levels. This in turn impacts both current year revenue and future revenues. 

Because of this continued decrease in the number of transports and the likelihood that it may continue in to FY 22, the FY 2022 revenue impact of increasing ambulance transport fees to the level originally proposed in the FY 2021 pre-COVID operating budget is 10 percent less than the original $200,000 proposal and is now estimated at $180,000. One option would be to approve the increase for January 1, 2022 which would then start in a post COVID-19 environment.

Proposed transport rate increases would be:

○ BLS Transport from $500 to $600

○ ALS-1 Transport from $650 to $780

○ ALS-2 Transport from $800 to $900

○ $10 per mile to $12 per mile

The chart below shows the percentage and source of ambulance billing revenue received in calendar year 2019 (the most recent year available). 

Self-pay32.25%
Medicare33.25%
Medicaid7.00%
Private Insurance26.75%
Workers Compensation0.50%
 

Medicare has a capped rate of $232 (not including mileage costs) for all transports, meaning they will only reimburse that amount per transport regardless of the actual cost to transport.

The Collection Process – The City via the Alexandria Fire Department (AFD) has long maintained a soft-billing approach by which an individual is sent three unpaid bill notices in the mail. If the collection attempt is unsuccessful after the third notice or 180 days after the date of the initial claim, invoice, or bill, the account is written off. AFD does not currently send unpaid ambulance transport bills to collections for further action. 

Fairfax County, Arlington County, Prince William County, & Loudoun County also maintain a soft billing approach. Arlington County does send delinquent accounts to the Treasurer’s Office for further review and action. The Arlington Treasurer’s Office might make additional attempts to send delinquent notices or to contact individuals with unpaid bills for payment. Accounts with unresolved unpaid balances are written off. Arlington does not send unpaid bills to collection agencies for further action. This practice is commonly known across multiple jurisdictions as a “compassionate” or a “soft” billing policy.

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