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Commissioner outlines new state law on ambulance billing; county to explore higher private-insurance reimbursement
Summary
Commissioner Steven briefed the board on House Bill 1385, which took effect Jan. 1 and allows private insurers to be billed at 400% of Medicare's published ambulance rate; county staff will work with the billing company to model potential revenue changes.
Commissioner Steven (first name given in transcript) told the Clinton County Board of Commissioners on Jan. 7 that House Bill 1385, effective Jan. 1, authorizes a higher billing rate for ambulance services to private insurers and could increase reimbursements for county emergency medical services.
Steven said the law permits billing private insurance companies at 400% of Medicare's published ambulance rate. He said the county’s billing company is helping staff understand how the statute will work in practice, including which insurers are subject to state-level management agreements and what the impact will be on revenue.
The commissioner said about 28% of the county’s payer mix is private insurance; the working plan under discussion is to bill private insurers at the higher rate while balance-billing Medicare, Medicaid and self-pay accounts as appropriate. He cautioned the board that the state has not provided complete guidance on all implementation details and that the revenue benefit might be less than originally anticipated for some insurers.
No formal action was taken; commissioners asked for further financial modeling and for the billing company to provide an exact proposal on fee schedules and projected reimbursement changes.
