Washington County approves Blue Cross agreement to speed EMS reimbursements

Washington County Commissioners Court on April 1 approved an ancillary provider agreement with Health Care Service Corporation (the Blue Cross Blue Shield plan) designed to streamline reimbursements to the county’s emergency medical services.

County officials said the agreement creates contracted payment rates that would avoid lengthy information-dispute-resolution (IDR) delays under federal law and speed money to the county’s books. Justin (county staff presenter) summarized the proposal as “basically a contract between us and Blue Cross Blue Shield… and, hopefully streamlining that payment process.”

The contract includes proposed average payments that county staff said are higher than historical averages. County staff presented two examples of historical averages and proposed contracted rates: air transport average payments rising from about $19,182 to $25,972 (roughly a 35% increase) and ground transport averages rising from about $1,119 to about $1,781 (roughly a 59% increase). Using those historical volumes, staff projected roughly a $300,000 increase in air-transport revenue and about $157,000 in ground-transport revenue (projections provided by staff).

County staff and legal advisers said the federal “No Surprises Act” and its IDR process have delayed prior payments for months or longer. One county staff member explained, “It wasn’t that we weren’t generating the revenue. It’s just that it wasn’t hitting our books, you know, up to 24 months out.” The court was told the proposed agreement would remove many claims from the IDR pipeline so payments are received on contract terms rather than waiting for dispute resolution.

County counsel and outside advisers raised legal concerns in prior email exchanges; staff said those concerns have been reviewed and that some issues are difficult to negotiate with a large insurer. A county legal adviser told the court that the county’s team had “made [the insurer] aware of our changes” and that, because Blue Cross Blue Shield is a statewide carrier, some contract terms may not be negotiable. Staff also said that EMS compliance contractors and the county’s internal reviewers had examined the contract and provided responses to the court in email.

Commissioners voted to approve the Health Care Service Corporation ancillary provider agreement. The motion passed with the ayes recorded and no opposing votes voiced on the record.

County staff said EMS will monitor the contract and that the county could cancel the agreement later if it proved unworkable for the department.