Mehlville fire district hires company to recover non-residents’ unpaid ambulance bills

Fitness-for-duty evaluations will begin in October under recently adopted policy

By MIKE ANTHONY

The Mehlville Fire Protection District will contract with a collection agency to recover unpaid bills for ambulance service incurred by non-residents.

The Board of Directors voted unanimously last week to contract with I.C. System of St. Paul, Minn., to recover non-residents’ unpaid bills for ambulance service, which total roughly $165,000 so far this year. The company will receive 30 percent of the revenue it collects.

Craig Walk, deputy chief of emergency medical services, first proposed having a collection agency recover unpaid bills for ambulance service in mid-July.

Regarding the unpaid bills, Walk wrote in a July 17 memorandum, “I have been informed by the district’s billing vendor, Mediclaims Inc., that they have never been given any direction as to whether these accounts are to be turned over to collections. The district’s resolution establishing ambulance service fees and billing policy clearly states non-residents are expected to pay any and all charges billed to them for ambulance service.”

The Board of Directors voted in 2002 to begin billing for ambulance service. The district bills the insurance company of a Mehlville resident who uses ambulance service and the resident does not make any co-payment. The district also bills the insurance company of a non-resident who uses ambulance service. Because a non-resident does not pay any taxes to the district, that person also is billed a co-payment for ambulance service.

Walk’s memorandum also stated, “Another situation that is very prevalent with the district’s ambulance service is the countless requests that are received from patients who are pursuing litigation — both residents and non-residents. A majority of those accounts have never been paid. I am requesting the board give permission for liens to be placed against these accounts — resident and non-resident — with the hope that eventually the district will recoup some of those charges for service.”

Besides recovering unpaid bills for ambulance service incurred by non-residents, I.C. System will seek to collect co-payments sent to residents by their insurance company, but not forwarded to the district.

“There is an additional situation I feel which should be brought to the board’s attention,” Walk stated in the memorandum. “There are instances where a district resident’s insurance carrier, predominantly Blue Cross/Blue Shield, will send their payment on the account directly to the resident. However, the resident then, in turn, fails to make the payment on their account for the services provided. The district’s resolution establishing ambulance service fees and billing policy clearly expects to receive any payment(s) from a resident’s insurance carrier for such service. I would recommend we pursue those residents who have received their insurance payment for ambulance service.

“When considering the aforementioned example of funds the district has failed to collect, I believe an attempt should be made to collect those fees to offset the continually rising costs of district operations,” Walk wrote.

At the Sept. 21 meeting, board Chairman Aaron Hilmer noted that Mathew Hoffman, the district’s legal counsel, had written a legal opinion regarding potential liens.

In an Aug. 24 memorandum to Hoffman, Walk wrote, “… I am requesting from you the district’s ability to either place liens against Medicare/Medicaid forced adjustments or liens placed against the original balance, and once the claim is settled, reimbursing Medicare/Medicaid for the payment received from the original billing.

“I am also submitting drafts for the aforementioned lien notice and correspondence that would be sent to a district resident, making them aware the district has been informed that they received payment from their insurance carrier for their claim.”

In a Sept. 7 response to Walk, Hoffman wrote that state statute allows for the assessment of fees to residents, noting the district resolution establishing ambulance billing states, “(W)hen a resident receives ambulance service, the district shall only collect that amount … which is payable under the resident’s insurance policy.”

Hoffman noted, “The phrase ‘insurance policy’ can be construed to include the policies under Medicare and Medicaid.

“Additionally, it is common for medical providers to assert a lien with regard to medical bills that remain unpaid during pending litigation. I have reviewed the proposed notice of lien and the proper statutory language is contained in the lien. Also, such a lien will help ensure that the district is named as a ‘payee’ on any type of settlement draft.

“Further, the proposed letter clearly identifies only those district residents that have been financially reimbursed by a third party,” Hoffman wrote.

In a separate matter Sept. 21, Assistant Chief Steve Mossotti noted that evaluations for the district’s new Fit for Duty policy will be conducted by ProRehab beginning in October.

Under the new policy, which was adopted last month, all 24-hour personnel with the rank of captain or below will have an annual fitness-for-duty evaluation. Such evaluations will determine whether an employee is:

• Fit to work without limitations.

• Fit to work with identified limitations.

• Not fit for duty.

Hilmer told the Call, “What started this whole process was I was contacted by several residents who were concerned about whether some of our firefighters could perform the job if they were called upon. So what we did here, we worked with Barb Cullen from Medical Services Management, who’s done great work for us helping to reform the work comp, and she pretty much drew this policy up along with our legal counsel, Matt Hoffman, to review it.

“What I think’s interesting about this policy is a couple of things. It’s not optional. It’s mandatory. You need to be able to pass the series of tests to ensure your future employment with the fire district. But also, it’s good for the residents. That way, they know that anyone who responds to a call can perform their job to the duties specified. It’s also good for their co-workers. If they’re in an emergency situation, they know that their co-workers can perform the job as necessary.”

The new Fit for Duty policy ultimately will reduce the district’s workers’ compensation premiums, Hilmer said.

“What’s good about this is we’re helping to develop a baseline for our entire work force. This is going to help us as our work comp reforms keep kicking in. So if someone is not quite fit for duty, we’re going to know that, know why and we’ll be able to use that as we consult with Barb Cullen … It’s all part of the work-comp reforms,” he said.