North Riverside trustees last month voted to more than double ambulance fees as officials seek to leverage a new program that allows the village to collect more revenue from Medicaid claims.
Prior to the Nov. 15 vote, the village charged $600 for basic life support and $1,200 for advanced life support in the event an ambulance was needed to transport a patient to the hospital.
However, the village often gets far less than it charges. The ordinance stated that the village would seek whatever revenue it could get from a third-party insurer, whether private or through Medicare or Medicaid.
The new ordinance, which went into effect upon adoption now charges all patients a base rate of $3,032 per ambulance run regardless of treatment, whether it’s basic or advanced life support.
The village will continue to bill the third-party insurer and accept whatever payment the insurer remits. There will be no additional attempt to recoup the rest of the fee, said Village Administrator Sue Scarpiniti.
However, the village ought to be able to recoup more of that ambulance charge from patients who qualify for Medicaid through a federal program known as Ground Emergency Medical Transportation (GEMT).
Scarpiniti said the change in the fee reflects the actual cost of providing the ambulance service and that there would be no change in the way the village seeks payment from those who have private health insurance.
“When participating in the GEMT program, you are no longer allowed to have different rates based upon the type of transport (ALS or BLS),” Scarpiniti said. “Going forward, there is only one blended rate based on the village’s actual costs to provide ambulance services as determined by the program’s eligible cost sheet.”
While GEMT has been around for years, it was only in 2019 that the Illinois General Assembly introduced the program to agencies within the state. In the past, Medicaid claims made to the state by the village for ambulance services were reimbursed at a very low rate, a couple of hundred dollars for a bill which, when other factors such as mileage and additional life-saving services such as oxygen were applied, would come to $2,000 or more.
GEMT allows the Illinois Department of Healthcare and Family Services and the municipality to split the remaining revenue owed, which is expected to add hundreds of thousands of dollars in additional revenue through ambulance fees.
While a figure was not included in the village’s 2021-22 budget, North Riverside Fire Chief Bob McDermott said he was “conservatively” estimating an additional $200,000 to $250,000 annually through the GEMT program based on the village’s roughly 200 Medicaid-eligible ambulance runs each year.
Based on Brookfield’s experience, McDermott could be underestimating the additional revenue.
Brookfield adopted the GEMT program in 2020 and began collecting the additional Medicaid reimbursement in 2021.
From 2018 through 2020, Doug Cooper, Brookfield’s finance director, said the village recouped an average of about $485,000 annually from ambulance charges. With GEMT in place, the village is on track to collect a little more than $1 million from ambulance fees in 2021 and has budgeted to collect $1 million in 2022.
That additional revenue, said Cooper, goes to fund the fire department’s budget, and such a revenue stream could help North Riverside fund its fire operations, including the department’s annual pension obligation.