MCOs affecting county ambulance reimbursements

By Xiomara Levsen, The JOURNAL


Washington County Ambulance administration staff spoke to the supervisors about how Managed Care Organizations (MCOs) are affecting its finances at the meeting Tuesday morning.

Administrative staff Jamie Brame said they seldom get paid straight from Iowa Medicaid anymore. The payments come through the contracted MCOs, Brame said. New legislation became effective July 31 and has changed what they will pay the ambulance service.

?So how it used to work is: if a patient was covered under Medicare but they didn?t have a secondary supplementary (insurance), they were covered under Medicaid,? Brame said, ?and whatever deductibles ? coinsurance ? whatever you have after Medicaid pays, these MCOs or Medicaid would cover.?

This added up to be 20 percent, she said. In the new legislation passed July 31 the MCOs have decided they won?t cover that 20 percent.

?So what that means is for us we will start writing that off,? Brame said. ?We can?t bill a patient for that. The Medicaid patients make up about 30 percent of our patients this year alone, so that?s about a $30,000 hit that we can?t collect on anymore.?

Last year, they wrote off $29,831, she added.

?And that?s just after Medicare pays,? administrative staff member Dixie Young added.

There are patients who don?t have Medicare at all and just have Medicaid because they can?t afford to pay for insurance. The way the ambulance service is paid from Medicaid has changed as well.

?They?ve lowered what they?re going to pay for that,? Bram said. ?Say we have a $1,000 bill, we might collect $100 [to] $150 on that, so it?s changed a lot with this new Legislature ? it?s a big difference.?

The legislation was put into an appropriations bill that Representative Dave Heaton is a committee member of, supervisor and Washington County Ambulance director Richard Young said. Heaton was asked about this bill and Heaton told him it didn?t happen but found out it did.

?I think he knew all along,? Young said, ?but they changed all the legislation this year for the MCOs. What it does is make more money for the MCOs and takes the money away from the providers that are actually doing the work ? hospitals, doctors, ambulance services ? they?re all getting us because of the legislation that was passed and signed by the governor before he left the state to go to China.?

Supervisor Jack Seward Jr. asked if he was correct in thinking the MCOs were all fully funded but the providers were not.

?Correct,? Brame said.

Seward told D. Young and Brame he appreciated them coming to the meeting, letting them know how it?s affecting them.

?Do you have that House File number with you?? Young asked Brame.

The House File number is 653, Brame replied.

?We?ve looked at it a lot,? D. Young said. ?She?s spent a lot of time on the phone calling these MCOs. We?ve spent more time in the last year and a half calling, begging for our money.?

Supervisor Bob Yoder asked if the county would have to subsidize the ambulance service more than they have in the past because of this.

?Thirty thousand dollars is a lot,? Bram said.

?That?s a whole employee,? D. Young added.

It?s a paramedic, and is hard cutting an employee from the service, Brame said.