A new audit report suggests ways Fairfax County leaders can improve collection rates and recoup more of the costs of providing ambulance services.
Even as that discussion starts, the county is working to collect payments for ambulance services provided last year after encountering problems with a contractor that left many bills in limbo.
With nearly 65,000 transports during a typical recent year, that means millions of dollars remain to be collected from residents or their insurers, according to the 20-page report, which was delivered to the county’s Audit Committee on Tuesday (April 8).
The findings of the county’s Office of Financial & Program Audit Team provided food for thought, said Dranesville District Supervisor Jimmy Bierman, one of four supervisors on the Audit Committee, which also includes two members of the public.
“Given the tight budget, I think it’s important to explore potential options,” Bierman told FFXnow.
“I understand that there are costs associated with these changes, so I support further evaluation of these options to see whether they would be feasible and likely to generate enough revenue to justify the costs,” he said.
Mount Vernon Supervisor Dan Storck, who chairs the committee, agreed the audit provided useful options.
“In our tough budget environment, I see this as a good opportunity to improve our collections and increase county revenues,” he said, saying the report identified “significant opportunities to improve the collections percentage and bring in more revenue.”
About 94% of Fairfax residents have some form of health insurance, county officials say. For residents who are covered, the county government collects what is reimbursable from insurance companies. Any remaining balance is waived for Fairfax residents.
Reducing or eliminating that waiver is one of several options available for boosting revenue, the auditors said. Others include raising existing billing rates and expanding the accepted payment methods beyond checks to include credit cards and other electronic means.
“These options present different trade-offs and would require further analysis to assess their feasibility, alignment with county values and overall impact,” the report noted.
For transported patients who are insured but don’t live in Fairfax, the waiver doesn’t apply. Non-residents are billed for any copays, coinsurance or deductibles left over after their insurer has made payment.
Uninsured individuals are billed directly, though those with incomes under 400% of the federal poverty line can apply for a waiver.
Current ambulance fees are:
- $750 for Basic Life Support (BLS) transport
- $950 for Advanced Life Support, level 1 (ALS1) transport (serious medical problems or traumatic injury)
- $1,175 for Advanced Life Support, level 2 (ALS2) transport (cardiac arrest)
- $18 per mile, from pick-up point to the hospital for ground transport
Though lower than recently increased fees in D.C., Fairfax’s charges exceed its neighboring Northern Virginia jurisdictions. Even so, they don’t cover the full cost of providing service, the report says:
In FY23, the average cost of one Fairfax County EMS response was estimated at $2,350. With the highest fee currently at $1,175 plus mileage per transport, Fairfax County does not recuperate the full cost for providing the service. However, rate increases to recuperate the full cost would mostly be passed to the patient and not the insurance company, as insurance companies have set rates of reimbursements.
Last October, Fairfax County awarded a contract for ambulance billing and accounts-receivables to Digitech Computer LLC after its existing vendor, Change Healthcare, experienced a cyberattack and data breach in February 2024 that disrupted payment-processing services for clients nationwide.
As a result, billing for Fairfax Emergency Medical Services operations halted until November 2024. Those accounts have now been transferred to Digitech, which is working to both address the backlog and collect on subsequently provided services.
Change Healthcare is still servicing billing for all EMS transports up to Feb. 19, 2024. Their contract expires in June.
While billing has been delayed, those that have gone out are generally correct, according to the audit report, which found only a “small percentage” of accounts had billing errors.
Mason District Supervisor Andres Jimenez, another audit committee member, said the report will prove beneficial as county leaders consider steps to improve the process.
“The detailed information provided will be invaluable,” he told FFXnow. “While the Board does not vote in committee, this data will be presented to the Board of Supervisors to guide further discussion.”
Jimenez noted with approval the proposal to accept electronic payments, including via credit card, as a step toward “making the payment process more accessible and efficient, which can ultimately improve revenue collection.”
That sentiment was echoed by Bierman.
“Many people no longer have easy access to checks,” he said. “If they are given the option to pay their bill with a credit card or other electronic-payment option, they might be more likely to promptly pay.”
The Dranesville District supervisor also expressed support for “adjusting billing practices [by] either sending more than three statements or extending the billing period beyond 180 days.”
The fourth supervisor on the audit committee, Springfield District Supervisor Pat Herrity, is recuperating from heart surgery he underwent on March 13, his staff said.
