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

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

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

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

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

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

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

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

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

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

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

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

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

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