Resident Services

Resident Services / Fire

EMS Billing Program Implementation Updates

Week of May 24
At the May 24 Council Meeting, Upper Arlington City Council authorized the City Manager to enter in to contract with MBI Solutions for the provision of third party billing administration for the City's impending EMS transport billing program.

Staff in the Fire Division are now in the process of finalizing billing details for the program, which will begin July 1, 2004.

Week of May 3
At the May 3 Council Conference Session, Staff presented a report on the process leading to its selected of MBI Solutions to provide third party administrator services for the EMS BIlling program.

Legislation to contract with MBI Solutions will have three public readings on the following dates:
- Monday, May 10, first reading and public hearing at the regular City Council Meeting
- Monday, May 17, second reading and public hearing at a Special City Council Meeting following the Council Conference Session.
- Monday, May 24, third reading, public hearing and Council Action.

Below is the Staff Report presented to Council:

To: The Honorable Clark P. Pritchett, Jr. and Members of Upper Arlington City Council

From: Mitch Ross, Fire Chief

Prepared for Meeting Dated: May 3, 2004

Subject:
1) – Selection of Third Party Emergency Medical Service (EMS) Billing Administrator
2) – Outline of Proposed Program Elements

Actions Requested:
1) – Approval to Enter into Contract with MBI Solutions, Fire/EMS Billing Services
2) – Approval of Proposed Program Elements

Master Plan Objectives:
Economic Development
- (1f) Monitoring cost recovery programs for City services
- (8e) Exploring non-traditional revenue source

Community Services and Facilities
- (3b) Updating City facilities to enhance service delivery and provide for expanding services as necessary
- (7a) Continuing to provide outstanding police, fire and emergency medical services

Implementation
- (2b) Identifying, pursuing and securing funds for prioritized initiatives of the Master Plan and Study Area plans
- (2c) Continuing to monitor and ensure fiscal accountability

Staff has proceeded with the next steps required for implementation of an Emergency Medical Services (EMS) billing following City’s Council’s authorization to move forward at its February 17 Council Conference Session.

Per the procedural steps outlined in the February 17, 2004 Staff Report on this issue, an EMS billing program outline was prepared, and a Request for Proposal issued to seek a third party administrator to handle billing collections.

A total of nine proposals were received from various firms, within the State of Ohio and beyond. After detailed review of these proposals, staff chose to interview three Ohio companies. These were:
- MBI Solutions, Fire/EMS Billing Services
- Medicount Management, Inc.
- HealthServe, LLC

While all three companies gave exceptional presentations and are capable of providing the services desired, Staff has chosen MBI Solutions as its preferred candidate. The primary factors that set MBI apart are as follows:
- MBI Solutions already successfully provides third party billing services to most Central Ohio communities currently implementing EMS billing programs.
- References from these local jurisdictions have been very positive.
- MBI Solutions has existing agreements with local hospitals that would enable the quick exchange of necessary information to expedite the billing process and minimize the time spent by Fire Division staff completing paperwork.
- MBI Solutions is already working successfully with Clayton IDS, which provides the Fire Division’s EMS software, resulting in the seamless transfer of data.
- MBI Solutions has a strong training component to ensure firefighters/medics fully understand the billing program, what is expected of them to complete paperwork correctly, and to emphasize customer service issues. Thorough training will also result in the collection of more accurate data, resulting in a better collection rate.
- Several key MBI Solutions representatives are former firefighters/medics, with a clear understanding of the many issues involved with the provision of exceptional, timely emergency medical services, and understand that providing quality EMS is the most important goal.

While not unique to MBI Solutions, other highlights of the services this company can provide are as follows:
- MBI has a toll free number staffed during regular office hours, with fully trained operators ready to handle any incoming billing inquiries.
- At our request, MBI Solutions will apprise the City of any customer service or billing problems that may arise, so that Staff can determine an appropriate response to resolve such issues.
- Professionals trained and experienced in Medicare and insurance billing issues and regulations.

From a fees perspective, MBI Solutions was not the lowest bidder. However, the scope of services offered, the company’s history servicing Central Ohio EMS providers, and its existing relationships with area hospitals should expedite the collections process and increase overall collections. These considerations resulted in a higher confidence level of MBI Solutions’ overall abilities and the recommendation before Council today.

On April 29, Staff conducted an onsite visit to MBI Solutions’ call center and offices in Kettering, Ohio, and discussed the proposed program in further detail to validate the high level of services and customer service MBI would be able to provide the City. Confidence level in MBI Solutions’ abilities and services was greatly enhanced – staff are qualified, highly knowledgeable and approachable, and the company has invested in a first-rate technological package, from its call system to its databases, with appropriate redundancies and back ups built in to assure the continuation of service at all times.

Contract/Program Details
Under the proposed contract with MBI Solutions:
- The City would be charged an 8.5 percent fee for all monies collected. In cases where none of the monies due are collected, MBI Solutions would not receive any payment.
- There would be no set up fee from MBI Solutions (Staff does anticipate a $2,495.00 software fee from Clayton IDS to incorporate the billing component).
- The initial contract would be for a period of one year, with the option to renew annually for a further two years (a total of three years). It can take several months for an EMS billing program to become fully operational, generating predictable income levels. Staff believes a one-year period would allow for this to occur, while providing an appropriate timeframe in which to review the success of the program with MBI Solutions and determine if the contract should be extended or other options reviewed at that time.

- The City would have an option to terminate the contract with MBI Solutions at any time, should it encounter an unacceptably high incidence of customer service complaints or fail to meet other contract requirements.
- MBI Solutions would implement a “soft billing” program on Upper Arlington residents’ behalf.
- It is anticipated that Medicare payments would comprise the bulk of revenues realized by the City. MBI Solutions would process and keep up-to-date on the necessary paperwork required for registration with Medicare.
- In general, MBI Solutions recommends that the City refrain from negotiating fee contracts with private insurance companies, as they typically result in lower revenues.
- City Staff would be closely involved with the development of all invoicing language and written communications disseminated by MBI Solutions on its behalf.

Fee Structure
Staff is still determining the proposed billing structure and would immediately begin work to set the fees with input from MBI Solutions following this May 3 Council Conference Session, to finalize what would ultimately be implemented. This would likely be consistent with fees charged by the City of Columbus and other local jurisdictions, with consideration of the actual costs incurred by the City for the provision of these services.

For example, Clinton Township and Plain Township are currently charging the following rates:
- Basic Life Support (BLS) – $503, plus $10.21 per mile
- Advanced Life Support 1 (ALS1) – $640, plus $10.21 per mile
- Advanced Life Support 2 (ALS2) – $865, plus $10.21 per mile

The City of Columbus is currently charging:
- Basic Life Support (BLS) – $423.64, plus $7.82 per mile
- ALS 1 & 2 – $727.00, plus $7.82 per mile

Within this price range, and the typical number of EMS transports conducted by the Fire Division each year, MBI Solutions anticipates annual net revenues in excess of $450,000.

Please note, while the City would set its fee structure, Medicare “allowable rates” are set by region and must be accepted as payment for Medicare patients.

The Typical Upper Arlington EMS Billing Process
EMS Billing Scenario Summary Sheet Attached
Since the proposed Upper Arlington EMS Billing Program is designed to capture existing financial resources available through Medicare and private insurance policies, Upper Arlington’s EMS billing process would be as follows:
- The EMS transport would take place at which time necessary patient information such as insurance details would be gathered if the situation allows.
- The EMS crew would complete and electronically submit to MBI Solutions full details of the transport.
- Once this information had been reviewed for accuracy, it would be coded for the appropriate level of services provided and the resulting fee.
- MBI Solutions would electronically submit the claim to Medicare or the appropriate insurance carrier.
- If no payment had been received, second and third claims would be sent to the insurance carrier at 30-day intervals.
- Upper Arlington residents would not receive a bill for the transport or for any outstanding balance even if they do not have insurance.
- Residents could receive the following communications:
- A letter requesting or verifying insurance information if it had not been obtained or correctly input at the time of the transport;
- In instances where a private insurance company sends payment directly to a resident, this resident would receive a letter requesting that these monies be forwarded to the City.
- Non-residents would receive up to three bills for any balance not paid by Medicare/private insurance, or for the entire amount in cases where they lack insurance. The City would be notified of cases of non-payment.

Public Relations Component of EMS Billing Implementation
As mentioned in the February 17 Staff Report, Staff has a public relations plan in place to effectively communicate the EMS billing program with residents, including:
- Public meetings and presentations. A series of public meetings is scheduled at the Fire Stations and Senior Center in the month of June, with representatives of MBI Solutions on hand to provide their expertise and assistance in explaining the program. These meetings will be promoted via advertisements and news releases. Staff has already given a preliminary presentation to First Community Village, and will give similar talks at local service organization meetings.
- Articles/media releases. A series of articles and media releases are scheduled for dissemination both leading up to implementation of the program and once the program is underway. Attached is an article that appeared in the Spring City inSight newsletter.
- Website. Information has been available on the City’s website since late February 2004 and is scheduled to be expanded as the program is developed and implemented.
- Informational Brochures. Brochures outlining the EMS Billing Program will be developed and made available as soon as components of the program are finalized.

The City recognizes that it is paramount it effectively communicates several key messages throughout its public relations activities:
- Patient care will not be compromised in any way.
- Residents should not be afraid to call for help at any time.
- EMS billing taps into existing funds incorporated and available within Medicaid and commercial insurance policies.
- EMS billing is a practice widely used nationwide and is proven to provide communities with long-term funding to support the increasing costs associated with emergency services, equipment and facilities without placing an additional burden on residents.

Use of Resulting Funds
Staff is recommending that the resulting revenues generated by the EMS Billing Program should be earmarked to support the fire and emergency medical services provided by the Fire Division, to include fire facilities and the purchase of fire and EMS apparatus when needed.

In 2000, City Council assigned .25 mils of property taxes received by the City to support equipment purchases within the City’s Capital Improvements Program each year. When this determination was made, Council was aware that this level of funding would not be sufficient to cover all costs for fire/EMS apparatus replacements and that an additional funding source would be necessary. Costs recovered through the EMS Billing Program would provide the logical funding source for such needs.

Conclusion
Upper Arlington City Council recognizes the importance and value of providing exceptional safety services to the community. In addition, results of the 2003 Community Survey clearly indicate that many residents rate safety high on their list of Upper Arlington strengths.

The costs for providing and enhancing emergency medical services are expensive by nature and continue to rise, and the City’s three fire stations are aging and in need of upgrades, expansion and/or total replacement.

The City must remain cognizant of threats to revenue sources such as Estate Tax revenues and the Local Government Fund and continue taking a proactive approach in seeking out alternate revenue sources.

Staff believes that billing for EMS runs provides a unique opportunity for the City to continue providing exceptional fire and EMS services to the Upper Arlington community. Most importantly, an EMS billing program would not change patient care in any way, and the Upper Arlington Fire Division would always provide the best emergency medical services to patients, regardless of the program, their medical insurance situation and ability to pay.

In conclusion, Staff respectfully requests City Council’s approval to enter into contract with MBI Solutions Fire/EMS Billing Services for the third party administration of the EMS billing program, and approval of the proposed program elements and fee structure.

Mitchell G. Ross, Fire Chief
Virginia L. Barney, City Manager

Week of April 12, 2004
Plans are moving forward for the City of Upper Arlington to implement an Emergency Medical Service (EMS) Billing Program. The program is tentatively scheduled to go into operation this summer, pending City Council approval.

Staff is currently reviewing proposals from third party administrators specializing in EMS billing and collection, and well equipped to stay on top of the many issues and policy changes that occur within the healthcare industry. It is anticipated the preferred candidate and proposed billing program will be presented to City Council at its May 3 Council Conference Session.

A series of public meetings will be scheduled in June to give residents an opportunity to meet with Staff members and representatives from the third party administrator. At this time, a program outline will be provided, with ample opportunity for questions and concerns to be discussed. Please watch local papers for these dates and locations as the time approaches. In addition, representatives from the Fire Division are available to give presentations to any Upper Arlington group if requested. Please call 583-5100 for details.

While relatively new to Central Ohio, approximately 85 percent of communities nationwide bill for EMS runs, providing an effective long-term means to defray some of the costs involved with EMS units. A billing program would not affect the City’s provision of prompt, comprehensive emergency medical services in any way, regardless of insurance coverage or ability to pay. It essentially enables the City to take advantage of existing monies available through private insurance and Medicare policies that provide for the costs involved with treatment and transport by an emergency medical provider.

Fire Division
City of Upper Arlington
3600 Tremont Road
Upper Arlington, OH 43221
Phone: 614-583-5100
Fax: 614-457-6620