Emergency Medical Service Ambulance Cost Recovery Program
Read an article in The Island 360 about this project. Click Here
FREQUENTLY ASKED QUESTIONS
When was the Port Washington Fire Departments ambulance service created?
The Port Washington Fire Department commenced providing ambulance service in 1927 with the purchase of a surplus United States Army ambulance.
How was this service funded?
Prior to 1979 the Port Washington Fire Departments “ambulance squad” was funded primarily through donations.
When and why was the Fire Medic Company formed?
The Fire Medic Company (FMCO) of the Port Washington Fire Department was created in 1979 due to increases in demand for emergency medical services, technological advances in the field of emergency medicine and an increase in required training. The mission of the FMCO was at that time and remains today to strictly focus on the treatment and transportation of sick and injured persons to local hospitals. The FMCO is funded through the Port Washington Fire Departments contracts for service with seven separate municipalities.
How many calls does the Fire Medic Company and the Port Washington Fire Department respond to annually?
In 2022 the PWFD/FMCO responded to 2,580 Ambulance Calls and 1,471 Fire Calls. For a fifth straight year the Port Washington Fire Department remained the busiest fire department in ALL of Nassau County. In comparison, back in 1979 when FMCO was created there were roughly 750 ambulance calls per year.
What are the call Statistics broken down by municipality?
|North Hempstead||1571 EMS Calls or 61%||729 Fire Calls or 50%|
|Port Washington North||345 EMS Calls or 13%||128 Fire Calls or 9%|
|Manorhaven||387 EMS Calls or 15%||131 Fire Calls or 9%|
|Sands Point||112 EMS Calls or 4%||185 Fire Calls or 13%|
|Flower Hill||84 EMS Calls or 3%||147 Fire Calls or 10%|
|Baxter Estates||57 EMS Calls or 2%||25 Fire Calls or 2%|
|Plandome Manor||4 EMS Calls or .15%||7 Fire Calls or .5%|
Is the Fire Medic Company ALL volunteer?
Yes, the Fire Medic Company is comprised of 72 dedicated volunteer members who selflessly spend thousands of hours each year serving and protecting the people of Port Washington.
How can an ALL-volunteer force handle this enormous call volume?
The dedicated volunteer members of the Fire Medic Company are supported by the members of the Port Washington Fire Department. Additionally, the Port Washington Fire Department employs 2 full time and 29 part time employees, whose duties primarily consist of supplementing the volunteer members. Employees supplement the volunteers Monday through Sunday 0600 x 1800 hours.
How much does it cost to supplement the volunteers?
In 2023 the Department expects to expend $724,000 on salaries to supplement the volunteers.
Why is the Department enacting “Cost Recovery?”
For many years, the villages the Department serves have been requesting the Department research whether it can bill a patient’s insurer for providing services to a patient. Over the past few years, we came to understand that avenues existed for the Department to commence billing, but it was an extremely complicated and expensive.
Then, on April 9, 2022, Governor Kathy Hochul signed into law the 2022-2023 NYS Budget. Part KK of this legislation amended Section 209-b of the General Municipal Law to allow fire departments previously not permitted to bill for ambulance services to begin doing so for a four-year period, beginning July 8, 2022.
This change in the law provides a much easier and less costly option to commence billing. The Department is now presenting a cost recovery option to the villages and the town who have sole authority to approve or reject the option.
Why was this legislation important?
This legislation provides fire departments access to revenue through the billing of insurance companies for some services and thereby provides taxpayers with some relief from increasing fire department budgets caused by an ever-increasing call volumes as well as ever increasing costs for supplies, state mandated training and overhead. Tax caps and hard financial times have forced many fire departments providing ambulance services to cease operations, primarily in rural and suburban communities.
When does the new law take effect?
The new Cost Recovery law took effect on July 8, 2022. Assuming the villages and the town support Cost Recovery, the Department does not anticipate enacting Cost Recovery until on or about June 1, 2023.
Does the law expire?
Yes. As presently written, the ability for fire departments and fire companies to recover costs expires on April 9, 2026. Absent some further extension or a permanent enactment of the law, fire departments and fire companies will not be able to bill after this date.
Is EVERY fire department going to just start “billing” for ambulance service?
No. Only a fire department, fire company, or fire district that holds a Certificate of Operating Authority from the New York State Department of Health issued prior to January 1, 2022, can bill for services provided on or after July 8, 2022. The Port Washington Fire Department has held a Certificate of Operating Authority from the New York State Department of Health since the certificate was established. In addition to the Port Washington Fire Department the Nassau County Police Department as well as numerous other not for profit and for-profit corporations hold a Certificate of Operating Authority from the New York State Department of Health permitting them to operate within the Port Washington Fire Department’s geographical area of responsibility.
Are there any restrictions on the use of monies received from ambulance billing?
Yes. Monies received from cost recovery must be used to offset the costs of providing ambulance services to the areas serviced by the Fire Department.
Is a separate account required for EMS Cost Recovery funds, or can the funds be placed in the general operating accounts maintained by the Fire Department?
The new law does not require that a separate account be formed. However, the Port Washington Fire Department WILL be segregating ALL funds recovered by municipality served.
Will the people of Port Washington feel a financial burden as a result of the Fire Department enacting a Cost Recovery Program?
No. Cost recovery for Emergency Medical Service transports relieves financial hardship on the Fire Department by recovering health insurance monies for which residents already pay for in their insurance premiums. If the municipalities do not permit the Fire Department to recover costs they may be leaving dollars on the table and asking citizens to make up the difference through fire taxes or donations. By choosing to bill, the Port Washington Fire Department has full control over how we define inability to pay, and have established rules with our billing administrator and competent local legal counsel covering those situations where cost recovery may cause an undue financial hardship to the people we serve.
Additionally, sick or injured persons WHO RESIDE WITHIN THE GEOGRAPHICAL AREA OF RESPONSIBILITY of the Port Washington Fire Department and are transported to the hospital that have any applicable insurance co-payments will have the co-payment charge automatically waived due to the assumed payment of Town/Village real estate and/or personal property taxes. A narrative will be submitted with all commercial insurance claims stating: “Municipal resident patient cost sharing obligations may be waived.” Deductibles will be billed to the patient.
What determines a person’s residence?
Appropriate NYS EMS Laws require documentation of ALL sick or injured persons that are encountered by EMS agencies. This information is documented on a Pre-Hospital Care Report (PCR). Part of the reporting process requires documenting the name, address and D.O.B. of the sick or injured person. Often this information is gathered from the person verbally or via personal documents. This information will be confirmed by the Department’s billing administrator. Example: If a person is a resident of Manorhaven but is picked up and transported from an address in Baxter Estates the patient’s co-pay will be waived due to their being a resident of the PWFD geographical area of responsibility. However, a person that is picked up in Sands Point and states they reside at an address outside of the PWFD geographical area of responsibility will be responsible for their co-payment. ALL HOME ADDRESSES provided by patients will be cross-referenced in the Department’s address database for validity.
Will uninsured persons be expected to pay out of pocket for emergency medical services provided by the Port Washington Fire Department?
NO. By law an uninsured sick or injured person that is transported to a hospital can NOT be “billed” for service.
What if an insured patient cannot pay the cost? Will there be a sliding scale based on income? A payment plan? Some other arrangement?
The Port Washington Fire Department will NOT be participating in a sliding scale based on income or payments plans. ANY person stating a hardship in their ability to pay will have their associated costs waived.
How will an Emergency Medical Service Cost Recovery Program not cause a financial burden on the people of Port Washington?
The Port Washington Fire Department has gone to great lengths to establish a policy of compassionate billing while still being 100% compliant with the State and Federal guidelines. As previously stated, co-pays will be waived for residents and the charges for EMS transport that include co-payments and deductibles may be reduced or waived, based on a patient’s financial hardship, as determined by the guidelines established by the municipality and the Department.
What factors can make a patient presumptively eligible for elimination of any balance due:
Patients who attest to any of the following circumstances will be eligible for elimination of any balance due:
- A patient whose household income is not in excess of 500% of the Federal Poverty Level (FPL)
- A patient that participates in State-funded prescription programs
- A patient who is homeless or received care from a homeless clinic.
- A patient that participates in Women, Infants and Children programs (“WIC”)
- A patient that is food stamp eligible
- A patient that is subsidized school lunch program eligible
- A patient that is eligible for other state or local assistance programs that are unfunded.
Will members of the Port Washington Fire Department or Fire Medic Company be determining a patient’s ability to satisfy an invoice related to the Cost Recovery Program?
NO. The leadership of the Port Washington Fire Department will NOT be involved in determining a person’s ability to satisfy the invoice they received for the Cost Recovery Program. ALL decisions will be made by the billing administrator based on policies and procedures that have been pre-determined. The Port Washington Fire Department will ONLY be informed of a case number and the amount of funds received. The billing administrator will not be informing the Department of reasons why a case was closed or why only a percentage of funds were recovered.
How does gathering a patient’s insurance information work?
At the time of transport, a significant amount of information is recorded at the scene from every patient on the Patient Care Report (PCR). The gathering of insurance information will be attempted. If it is not recovered, it is the responsibility of the billing administrator to locate the proper information.
NO ADDITIONAL TIME WILL BE TAKEN AND NO DELAYS IN PATIENT TRANSPORT WILL OCCUR FOR THE GATHERING OF INSURANCE INFORMATION.
Where will the patient’s insurance information be recorded?
The patient’s insurance information will either be written down on the PCR or insurance cards may be photographed/scanned with the PWFD PCR tablet and uploaded into the system. Member’s phones are strictly prohibited from being used. ALL information is then uploaded and double encrypted when transmitted to the billing administrator.
What happens once a PCR has been completed and transmitted to the billing administrator for processing? How will the costs be recovered?
- 1st Step – EMS Personnel record proper medical insurance at time of transport and claim is processed by the billing administrator.
- 2nd Step – If EMS personnel are unable to record proper medical insurance at time of transport the billing administrator will utilize a computer program in an attempt to locate the patient’s information. If the information is located, the claim is processed. If not-
- 3rd Step – If the billing administrator was unable to locate the patient in the initial computer survey the billing administrator will then utilize another more enhanced computer program. If the information is located the claim is processed. If not-
- 4th Step – The billing administrator will attempt to make contact with the patient via telephone at any of the phone number(s) that may have been provided at the time of transport. ALL Calls are made by Certified Ambulance Coders (NAAC) or Certified Ambulance Privacy Officers (CAPO). If the information is recovered the claim is processed. If not-
- 5th Step – The billing administrator will attempt to make contact with the patient via written document that will be sent to the home address provided to the EMS crew at the time of transport. The form is NOT A BILL it is simply a request to provide Insurance Information. If the patient or their representative responds in writing or with a telephone call to the billing administrator and provides the requested information the claim is either processed or CLOSED based on PWFD policies and procedures.
*** The billing administrator will do all they can to avoid sending the Request for Insurance Information form.
What if a patient simply refuses to cooperate with the cost recovery process?
- After 60 days ALL cases with balances due under $200 are marked closed
- ALL debt is forgiven after 90 days even if amount due to the Department is greater than $200
- If after 90 days the party does not respond the case is closed
What if the patient’s bill is greater than their insurance company agrees to pay?
Aside from co-payments and deductibles the Port Washington Fire Department will ONLY accept what the insurance provider agrees to remit.
What if the patient’s deductible is greater than the cost of the services provided?
Deductibles are selected or chosen by individuals. The Port Washington Fire Department has no say or input in the patient’s decision-making process when choosing their deductible. Individuals know what their deductibles are long before they need to use them. And yes, for a multitude of reasons a person may have chosen a high deductible and may have difficulty satisfying said amount due. With that said, please refer to the 60 and 90 day procedures outlined above. Additionally, please know that the Port Washington Fire Department has enacted a compassionate billing practice and all the patient needs to do is convey their financial hardship or situation to the Certified Ambulance Coder (NAAC) or Certified Ambulance Privacy Officer (CAPO) and the situation will be remedied.
While walking on Main Street I trip and fall and hit my head. A bystander calls 911, and the Port Washington Fire Department ambulance arrives. Other than a small laceration to my head I feel fine and am treated and released at the scene. Will I be charged for this service?
NO. Due to the fact that the patient was “treated and released” at the scene or “refused medical attention” altogether there will be NO associated cost recovery involved. The Port Washington Fire Department policy is that cost recovery is only attempted for sick or injured persons that are transported to a hospital.
I am a resident of “Port Washington” and my cousin from out of town is visiting my home. They are transported to a local hospital having a medical emergency. Their insurance covers the cost of the services provided by the Fire Department but they have to pay the co-pay, deductible or co-insurance? What is the typical range of these costs?
There are many answers associated with this question. To begin the co-pays vary based upon the individuals insurance. For example, the co-pay for Medicare is dependent on the patient’s individual Medicare plan. As for private insurance, the co-pays typically vary from $50 to $200. As for the patients deductible or co-insurance, that cost varies as well based upon the plan the patient has selected. Another reason this question is not easily answerable is when was the transport? Was the transport in close proximity to the patient’s annual renewal of their plan? Is it at years end and they have already met their deductible or is it somewhat into the year and they have already satisfied their deductible? Or is their deductible high and very hard to actually reach? These are all reasons why the Port Washington Fire Department has adopted a policy of compassionate billing and has a “hold harmless” provision for ANY unpaid balance of $200.00 or less. Within the “hold harmless” provision ANY patient owing $200.00 or less will be sent ONE invoice and if that invoice is not responded to all debt is forgiven.
How do you attest to being unable to pay or that the situation has presented a financial hardship?
With the Departments compassionate billing practice all the patient needs to do is advise the Certified Ambulance Coder (NAAC) or Certified Ambulance Privacy Officer (CAPO) of their issues and the situation will be remedied. There is no written documentation such as a W-2, Tax return or bank statement that needs to be presented. Though the case will be closed verbally over the telephone the patient will however be mailed an Ambulance Transport Fee Financial Hardship Form. This form is expected to be filled out and forwarded back to the billing administrator. In the event the form is NOT provided to the billing administrator the case will remain closed.
If the case is being closed verbally over the telephone, why is the Department still requiring that the Ambulance Transport Fee Financial Hardship Form be filled out and forwarded back to the billing administrator?
Due to Medicare and Medicaid along with the private insurance industry being involved, the Federal Governments OIG or Office of Inspector General can audit any and all claims at any time. The OIG will question and investigate why fees were waived for some if the United States Government, New York State Government or private insurance carriers were required to satisfy balances. By completing or attempting to complete these documents the Port Washington Fire Department will remain compliant with State and Federal regulations.
What out of pocket expenses can sick or injured persons that are transported expect?
- Sick or injured persons that RESIDE within the Port Washington Fire Department geographical area of responsibility will automatically have their CO-PAYS waived. They will however be responsible for any deductibles associated with their insurance plan. Again, please refer to the Departments compassionate billing policy.
- Sick or injured persons who DO NOT reside within the Port Washington Fire Department geographical area of responsibility will be responsible for both a CO-PAY and the deductible associated with their insurance plan. Again, please refer to the compassionate billing policy.
- Other than the “Co-Pay” or “Deductible” the Port Washington Fire Department is prohibited by law from collecting any additional funds other than what is paid by the patient’s insurance provider.
Will patients that do not “pay their bill” be placed into collection?
The ONLY persons that will be placed into collections are those who receive compensation directly from their insurance provider and cash said insurance check and DO NOT forward the funds received to the Port Washington Fire Department. The claim will then ONLY be forwarded to the credit bureau if the patient is unresponsive to numerous attempts to contact them.
How much will the Port Washington Fire Department be invoicing my insurance for transport to a hospital?
|The Port Washington Fire Department has adopted “fair and reasonable rates”.|
|Basic Life Support – $1,500.00|
|Advance Life Support 1 (ALS 1) – $2,200.00|
|Advanced Life Support 2 (ALS 2) – $3,000.00|
|Transportation (from scene to the hospital only) per “LOADED” mile $35.00 (Rounded to the nearest 10th of a mile)|
What will Cost Recovery Achieve?
|The Port Washington Fire Department expects its Cost Recovery Program to:|
|1.Hold the line for the near future on the portion of taxes that fund Emergency Medical Services in the Port Washington community.|
|2.Provide EMTs and Advanced Life Support (ALS) technicians (either AEMT-CC or Paramedic) during times when PWFD volunteers of equivalent training may not be available to respond. To ensure this:|
|3.Provide an Advanced Life Support EMS technician to be available 24 hours a day, 7 days a week|
|4.Provide additional staff as required to operate an ambulance 24 hours a day, 7 days a week|
Will Cost Recovery increase EMS operational efficiency?
In conjunction with Port Washington Fire Department volunteers, cost recovery will provide sufficient Emergency Medical Technicians to allow Advanced Life Support Technicians (ALS) only transport patient in need of advanced procedures, thus freeing up the ALS technicians for additional multiple alarms – which typically are almost 20% of ambulance calls in Port Washington. Cost Recovery will additionally free up PWFD volunteers from various administrative and maintenance duties to allow them to do what they originally volunteered to do: Go on ambulance calls.
Will Cost Recovery change anything about Port Washington Fire Departments Emergency Medical Service other than recovering cost?
- Instituting Cost Recovery will NOT change the basic ambulance operations procedures: Both the members of our public and the PWFD volunteers and employees will continue to participate in ambulance calls and there will not be any difference in the way EMS is carried out in our community. The ONLY exception will be that Advanced Life Support providers will be much more readily available on all calls.
- Instituting Cost Recovery will NOT change the way people call for an emergency ambulance: Whether members of our community call the Nassau County Fire Communications Bureau “Fire-Com” at 742-3300 or they dial 911, the call will still go to the PWFD the fastest way possible.
- Though we are instituting Cost Recovery the Port Washington Fire Department will NOT provide extensive transport services currently provided by commercial and hospital-based providers (so it will not be competing with them for billable patients). The Port Washington Fire Department has recognized the importance of these other ambulance services operating in our community to provide scheduled and non-emergency transport between private residences and nursing homes and hospitals and clinics. They have always relieved the Department of the burden of responding to these somewhat more routine transport needs and will continue to do so. In this way the Port Washington Fire Department will be that much more available for true emergencies.
How will Cost Recovery = A Better Future for the Port Washington Fire Department Emergency Medical Service and the people we serve?
- By instituting Cost Recovery, the Port Washington Fire Department will be:
- Holding the line on the current level of tax funding for Emergency Medical Service operations for the near-term, by making insurance companies pay for a significant portion of our community’s Emergency Medical System costs, using funds they have already been collecting from our citizens.
- Providing paid Advanced Life Support (e.g., Paramedic) staffing of an ambulance 24/7
- Providing paid EMTs and / or ALS technicians to fully staff at least one and often two ambulances during times of high call volume when PWFD volunteers may not otherwise be available.
- Supplementing the continued participation of the PWFD volunteers to provide reliable ambulance coverage for first ambulance calls as well as most second calls 24/7
- Allowing for efficient use of ambulance crews to maximize the availability of an ALS technician for additional 2nd and 3rd simultaneous ambulance calls.