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New EMS billing structure approved by Granite Shoals, Burnet County

Marble Falls Area EMS Executive Director Johnny Campbell

Marble Falls Area EMS Executive Director Johnny Campbell makes a presentation to the Granite Shoals City Council at its regular meeting Tuesday, May 10. Campbell started the day with the same presentation at the Burnet County Commissioners Court meeting in Burnet. Staff photo by Suzanne Freeman

Marble Falls Area EMS is making the rounds of government entities asking for — and getting — modified service contracts with streamlined billing. On Tuesday, May 10, EMS Executive Director Johnny Campbell made successful presentations to the Burnet County Commissioners Court and Granite Shoals City Council. 

He will make the same presentation to the Marble Falls and Meadowlakes city councils next week. The following week, he will speak to the boards of Burnet County Emergency Service District No. 9 (Spicewood) and ESD No. 1 for Burnet and Llano counties (Horseshoe Bay, Blue Lake, Sandy Harbor, Oak Ridge).

The new billing system does away with line-item charges for each individual drug or medical procedure administered per patient. Instead, EMS bills will include only base rate and mileage. 

“What we are proposing should not generate a larger bill,” Campbell told after the meetings. “It’s just taking all those extra line items and dumping them into a base rate and mileage average.”

In fact, by combining everything into base rate and mileage, the overall amount collected from insurance will likely increase. 

“Some insurance will only pay base rate and mileage and deny add-ons,” Campbell said. “This is a more efficient way.” 

One reason for the change is medication shortages. By the time a medication list has been approved, it changes, Campbell said. 

“It makes the list obsolete,” he continued. “This new process gets rid of the medication list.” 

While the new procedure simplifies emergency medical services billing and will most likely increase insurance reimbursements, it will not improve the perennial problem of collections. Only 4 percent of unpaid bills sent to collections are ever paid, Campbell said. That includes people with no insurance and those who do not pay the balance bill sent to them. This does not include Medicare or Medicaid patients, who account for 64 percent of the population served.

The average gross charge per trip is $2,074.24. Of that, only $646 is recovered, mostly through Medicare or Medicaid and supplemental insurance coverage. 

Currently, Marble Falls Area EMS has $326,345 in bad debt for the 2022 fiscal year, which ends in October. By the end of the fiscal, the total will be about $1.1 million, Campbell said. The collection rate is about 4 percent. 

Burnet County Judge James Oakley asked how EMS can survive with such a low collection rate. 

“Fundraisers and stipends,” answered Campbell, showing a pie chart to explain. 

Collections account for 52 percent, donations 0.52 percent, grants 0.51 percent, and fundraisers 0.53 percent. Contracts with cities and ESDs accounts for most of the rest. The largest are ESD No. 9 at 12.92 percent, ESD No. 1 at 10.79 percent, Burnet County at 10.32 percent, and Marble Falls at 4.52 percent.

Marble Falls Area EMS covers 350 square-miles with five ambulances and 40 employees that go out on about 5,000 calls a year. It contracts with five cities, three emergency service districts, and Burnet County, which covers a population of about 35,000.

Hospital-to-hospital transfers are about 13 percent of Marble Falls Area EMS business. About 87 percent of the calls are 9-1-1, and, of those, around 68 percent result in a hospital transport. The service averages about 60 transports a month. Most of the patients, 64 percent, are billed through Medicare. 

“Our billing company says this (new procedure) is more acceptable,” Campbell said of the proposal. “A lot of EMS services are going to this now. We are trying to get ahead of the game a little bit and move forward on that.” 

Both the Burnet County Commissioners Court and the Granite Shoals City Council approved the changes. 

CORRECTION: The original version of this story indicated that most of the EMS calls were for hospital-to-hospital transport. Actually, around 87 percent of the EMS callouts are for 9-1-1. Of those, around 68 percent result in hospital transport. Hospital-to-hospital callouts make up 13 percent of the business.