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Tuesday, December 26, 2023
EMS lost $33M after failing to bill patients?
By Andrew Walden @ 12:01 AM :: 1534 Views :: Honolulu County, Health Care

by Andrew Walden

Responding belatedly to a request for comment for our December 16, 2023 article on EMS billing failure, Shayne Enright, PIO for Honolulu Emergency Services Department, provides the following statement.  We have added in the mathematical calculations:

The 2021 Hawai‘i State Legislature regular session passed Act 208 and Governor David Ige signed a law requiring the City and County of Honolulu to take over the responsibility of Emergency Medical Services from the State of Hawai‘i. The change in legislation allows the City and County of Honolulu to collect the revenue from billing for the first time.

DO THE MATH: City and County of Honolulu had nearly a year to prepare for the July 1, 2022 handover, but somehow didn’t get the billing contract established.  

Prior to July 1, 2022, the City and County of Honolulu Emergency Services Department, Emergency Medical Services Division (EMS), was contracted and funded by the State of Hawai‘i Department of Health’s Emergency Medical Services and Injury Prevention System Branch to operate ambulance services within the City and County of Honolulu. For more than 30 years, the City provided the services to the public and ambulance transport revenue was deposited into the state’s general fund.

The new billing vendor, EMS Management & Consultants, was awarded the billing contract in October, 2022.

Unfortunately, ambulance rides during the July-October period were not billed until a year later.  Ooops.

The ambulance service rate is approved annually by the State of Hawai‘i Department of Health pursuant to the Hawaii Administrative Rules, Title 11, Chapter 72 with transport fees ranging from $1,995 - $2,240. This is regulated by the Director of the Department of Health for the State of Hawaii. The City only bills for transports. The City does not bill for those who refused transport or if a 911 call was canceled. 

From, July 1, 2022-December 15, 2023 the Honolulu Emergency Services Department, Emergency Medical Services Division (EMS) responded to 156,498 911 calls. 

DO THE MATH: 156,498 / 17.5 mos = 8,943 calls per month.

Approximately 46% of the responded calls are not billable. Of the responded calls, 84,061 calls are billable and the contractor has sent bills to the addresses on file.

DO THE MATH: 8,943 per month x 0.46 = 4,113 billable calls per month x 4 months = 16,452 billable calls July-Oct 2022 x $2,000 per call $32.9M lost due to failure to timely bill services from that four month period until nearly one year later.

These individuals were treated and transported to a nearby emergency department. The patient’s type of insurance will determine the reimbursement rate and patient’s copay. The reimbursement rate is rarely the full amount of the ambulance transport fee. This varies with insurance carriers and plans.

CLUE: Bills not timely submitted are denied by insurance carrier.

The City and its billing vendor has taken the appropriate steps to review each transport and process claims. The City is also taking the appropriate actions to assist with timely filing to maximize collections.

The article states a “substantial portion of rides are homeless drug addicts”, this inaccurately identifies the transported demographics. Over the past 18 months, approximately 2% of the total responded calls were to houseless individuals.

DO THE MATH: 4,113 rides / 0.02 = 82 bums per month.  But CB reports “8,228 visits by 2,850 homeless people in the last full year before the pandemic” -- just at Queens.  This equals 686 per month / 8,943 EMS ambulance rides per month = 7.7%.  On one hand that calculation does not include other hospitals, on the other it does include bums who wander in without an ambulance ride.  So we will leave it to the readers to decide what is ‘substantial.’

MEANWHILE: HMSA and EMS are now negotiating over the unpaid ambulance bills from July 1, 2022 thru October, 2022.

---30---

Related: Loss of $192M? Honolulu EMS forgot to bill ambulance patients for over a year

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