BOS tackles rescue, billing, reimbursement puzzle

The Rappahannock County Board of Supervisors spent nearly an hour at its Monday afternoon session (Dec. 7) trying to sort out who — when an ambulance ride is called for — should bill whom for what.

In what could be a preview of the coming years — when many say the county’s leadership and citizens will be paying much attention to the essential services of those who who are never paid (that is, its all-volunteer emergency responders) — the supervisors considered at length the case of the Amissville Volunteer Fire and Rescue Company.

The company’s leadership had been worried enough about getting properly reimbursed for the transport last year of about half of its ambulance calls to medical facilities that they hired an attorney, David Konick, to speak for them from amid the sparsely populated benches of the courthouse on Monday afternoon.

That not-quite-half is the percentage of patients needing transport from Culpeper County, where Amissville’s volunteers frequently respond. In years past, Rappahannock’s companies had worked out agreements with the companies — some paid, some volunteer — in surrounding counties, including Culpeper, to not charge for calls made by a Rappahannock-based company to a neighboring county, a courtesy generally reciprocated by the other counties.

But as those counties have increasingly moved to paid services (and Rappahannock remains one of the few in the state with all-volunteer emergency responders), and as funding becomes more challenging, the process and agreements have grown more complex and difficult to manage.

Then, in 2013, the supervisors, with the support of the county fire and rescue association, passed a “EMS cost-recovery” ordinance, which allows the county to bill Medicare and other insurers of those whom the volunteer companies transport. It went into effect in January 2014.

Over the next year and a half, through June 30 of this year, the system collected about $279,000 — for, as the ordinance explicitly stated, transportation only of Rappahannock County residents (language that County Attorney Peter Luke told the supervisors Monday that he’d included specifically to avoid conflicts with the out-of-county transport agreements). Based on a points-per-call system, about $120,000 of that revenue was distributed to the county’s seven volunteer companies in June of this year.

But Fidelis, the company contracted by the county to do the billing to Medicare and insurance companies, apparently billed for more than $20,000 in transports that Amissville VFR carried out for Culpeper County residents. Which is what brought the issue to the supervisors, for a possible amendment of the ordinance.

Luke told the supervisors Monday that it was his opinion the supervisors should send back all of that money billed to Medicare and other insurers, before taking any further action.

Amissville’s leadership, through Konick, disagreed.

“Medicare doesn’t care about what happened here, and that your ordinance says [that out-of-county residents’ insurance will not be billed],” Konick said. “All Medicare wants to know is, was a call made — answer: yes — and, if so, was it eligible for Medicare reimbursement — again, the answer is yes. If you send the money back, you will just awaken the Medicare sleeping dogs, and they’re going to start wondering what’s wrong.”

The supervisors, after a long and not-quite-heated discussion, agreed with County Administrator John McCarthy’s recommendation that the county first work out new agreements with Culpeper (and likely Warren, and Fauquier) that reflect the realities — that there’s no fraud involved, first of all, since all the billing is for calls that are legitimately made by emergency responders; and that neighboring counties’ emergency responders, both paid and volunteer, are also billing insurers for ambulance rides made from Rappahannock County.

The board tabled the matter until next month, by which time Luke said he and Deputy County Administrator Debbie Keyser hoped to have met with the proper Culpeper County authorities to work out a revised agreement.

Since the June disbursement of EMS cost recovery revenue to the fire and rescue companies, said EMS manager Richie Burke, “the [reimbursement] process is kinda on hold at the moment, until we settle this issue. This whole process was started out all in good faith, and it will take some time to work it out. Warren County, they took about five years to figure out how to work out their billing system.

“So Debbie Keyser, myself, the fire and rescue association, the chiefs committee — all of us are working to fine tune this system,” said Burke.  

In other actions, the supervisors approved an amendment to the current year’s budget of $1,796 — representing interest the county paid on money it had to borrow to bridge the cash-flow gap between the midsummer start of the fiscal year and the fall collection of property and real estate taxes.

McCarthy pointed out that Treasurer Debbie Knick had managed to divert the borrowed funds into an interest-bearing account — which brought the county more than $5,000 in interest, for a net gain of more than $3,000. The supervisors approved the appropriation unanimously without comment.

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