First Responder Fee Treat and Release Fee

1. First Responder Fee Treat and Release Fee A/C Scott Clough March 28, 2013

2. FRF/ TRF What is it? • Legal, ethical, honest billing for services that is recognized by most private insurance companies • Is charged for all encounters that result in a patient assessment • Has NOTHING to do with ambulance transport • Is not regulated by your LEMSA

3. FRF/ TRF What is it not? • It’s not a “crash tax” • It’s not a money grab • It’s not a scam

4. FRF/ TRF How does it work? • Metro passed a resolution allowing the billing to take place • We established a fee schedule based on costs • There are two costs; • First Responder Fee is bundled into the transport cost • Treat and Release Fee is billed for non-transport

5. FRF/ TRF Projections • 80,000 calls for service annually/ 73% are EMS = 58,400 • 72% transport rate = 42,048 • 20% collection rate on FRF and TNT = 11,680 • $275.00 per contact • Total collection/yr = $3.2 million – 2% of budget

6. FRF/ TRF Methodology • Average time on task E/T = 20 minutes • Average hourly rate per unit = $150.00/hr. • 58,400 calls / 3 (20) = 19,466/hrs on task • 19,466 x $150.00 = $2,919,900.00

7. FRF/ TRF Actual reimbursements to date • Collection rate is about 17% • 17% collection = 9,928 billable calls • 9,928 x $275.00 = $2,730,200.00

8. FRF/ TRF What is the backlash and how do we handle it? • Since introduction in February 2012 - 67 complaints • Most will come from senior groups – most vocal • Explain that taxes do not cover the full cost of service • Explain the cost of response and treatment of “individuals” medical cost

9. FRF/ TRF What is the backlash and how do we handle it? • Most will come from senior groups (continued) • “Individual” treatment above and beyond suppression is costing all tax payers • Without supplemental payments the service would be cut back or eliminated • “Individual” service that can be covered offsets the cost and allows continuation of medical services • Because 20% of patients have FRF/TNT coverage it allows us to wave the fee for those who don’t

10. FRF/ TRF • Auto insurance coverage • Statewide mandate • Needs to be looked at the same as work comp • Medical coverage is paid on first come first serve • Pays the full cost of transport if there is money to cover it • Most if not all insurance providers have a 1st responder covered amount • Not billing is disenfranchising the policy holder

11. FRF/ TRF • Auto insurance coverage • Metro does 6 MVA transports per day 3 are insured • Average transport = $1640 + $275 = $1915 • 3x $1915 x 365 = $2,096,925

12. FRF/ TRF How do you get this started in your department? • Need to have Board approval and pass a resolution • You do not need to have LEMSA approval for FRF/TNT fees

13. FRF/ TRF How do you get this started in your department? • If you receive FRF pass through from ambulance co. can you still collect? • If the ambulance is not billing a separate line item for FRF • If the pass through is for compliance purposes (stopping the clock) • If the pass through is considered a dispatch fee

14. FRF/ TRF How do you get this started in your department? • You must obtain an NPI number • BLS counts and will be reimbursed at the BLS rate • Dead bodies pay $$$ • Medicare = $532.00 • Medi-Cal = base ALS rate for ALS intervention