Since 1995, Federal, State and Insurance Industry reimbursement rates for medical procedures, treatment and transport have been the subject of debate. HCFA, the Health Care Financing Administration (Federal) has been overseeing meetings to balance the cost of medical procedures vs. fees paid.

Ongoing changes in healthcare industry reimbursement rates, specifically emergency medicine, have forced modifications to the billing procedures. The City of Burbank currently meets all standards.

In order to comply with future billing regulations, the Burbank Fire Department "Paramedic Ambulance Services" fee schedule, will need to be amended in a series of steps.

The Fire Department invoices for Emergency Medical Transport (Paramedic Ambulance Services) through a private contractual service. This outsourcing became necessary as the billing specialty for medical services increased. Through the use of "Wittman Enterprises", the City has been able to increase collection rates and dollars. Additionally, Wittman Enterprises has kept us abreast of changing trends within the prehospital billing industry.

The latest change, possibly having the single largest impact on prehospital billing rates will be phased in over a 5 year period that began as of April 2002. This rate change is a direct result of negotiations between Federal, State, Local and Private Providers with Medicare.

The current Paramedic Ambulance Services Fee Schedule denotes a fee of $444.00 for basic "transportation with no specialized services rendered"(BLS) and $528.00 for "Specialized Services rendered"(ALS). These rates are approximately $30.00 and $100.00 respectively, below the current maximum allowed rate for ambulance providers as outlined in the current "General Public Ambulance Rates" schedule established by Los Angeles County.

While Los Angeles County allows this rate, the new Medicare HMO rates will only pay 50-70% of the Fire Department fee schedule. The result of balancing these payer rates will result in a negative impact to the Fire Department Revenue of approximately $122,000.00 the first year.

The Fire Department proposes a series of step changes to maximize the allowable return while staying within the limits of Medicare allowed billing. The first step, while not having an initial major impact, will move in this direction. Subsequent changes at the start of each fiscal year will attempt to curb the loss of revenue as dictated through the Medicare reimbursement process.

The benefit in aligning the fee schedule with the Medicare rates is to the patient. The individual will have better payment coverage related to their insurance benefits if the Fire Department fee schedule stays in line with Medicare rates.

With the decreasing Medicare/HMO reimbursements proposed over the next 5 years, these incremental increases as weighed against the losses will not fully offset the decreased revenue.

Proposed revenue loss due to Medicare HMO Losses in first year: <$122,195.00>

Proposed revenue increase due to mid-year fee schedule adjustment:

Conclusion and Recommendations

The Burbank Fire Department staff recommends the immediate modification to Article V-Public Safety, "Paramedic Ambulance Services" fee schedule as follows:

(A) 1. "No special services rendered" - current $444.00 proposed $458.00

(A) 2. "Specialized Services rendered - current $528.00 proposed $568.00

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