Phillipsburg ambulance billing, compliance and staffing problems prompt county review and next-week agenda item

Commissioners for Granite County spent an extended portion of their meeting reviewing operational and billing problems reported by Phillipsburg-area ambulance volunteers and private ambulance representatives, and agreed to put billing and related contract items on a future agenda.

The discussion, opened by ambulance association representatives Frank Breds and Monica (last name not specified), described multiple problems: patient-care reports were not being submitted on time or consistently for runs; billing for Medicare and other payors was not being done in a way the speakers said would recover revenue; and there was confusion about which entity held the Medicare/Employer Identification Number (EIN) for billing. Robert (“Little John”) Littlejohn and Phillipsburg ambulance leadership participated by Zoom and said they would help remedy some items on return.

County leaders and ambulance representatives said the problems have financial and compliance implications. The ambulance representatives said they had not received a number of PCRs (patient care reports) needed to bill insurers, and that some runs were billed to an incorrect Medicare number. “We’ve sat on over 100 patient care reports for two years that we tried to rebuild,” one speaker said, adding that missing PCRs prevent billing and can put the ambulance out of compliance with Montana rules.

Frank and Monica said the administrative burden has led them to propose three near-term steps: (1) set up a separate legal/tax entity and Medicare/EIN number for Phillipsburg ambulance so runs out of Phillipsburg can be billed correctly; (2) consider a short-term mutual termination or change to the county’s billing arrangement if compliance cannot be achieved; (3) evaluate whether continued hard billing is worth the effort given most local transports are to Medicare and yield little net revenue.

Commission Chair Scott (last name not specified) and other commissioners directed staff to place the billing contract and related items on the next week’s agenda. Commissioners and ambulance leaders also discussed operational items such as drug storage/accountability, ImageTrend electronic PCR reporting, and the possibility of paying a dedicated full-time billing staffer. Ambulance representatives estimated a dedicated billing/administrative hire could cost about $75,000 per year; they said some high-cost drug administrations on single calls can approach $1,000 and that volunteers and the private association currently cover many immediate costs.

Speakers also described a complicated history of prior billing arrangements with a third-party named in the meeting as Soulstone (variously spelled in the transcript), which county and ambulance representatives said had not provided reliable PCR transmission or billing records.

County and ambulance leaders agreed on several next steps: county staff will help set up a distinct Medicare/EIN/tax identity for Phillipsburg ambulance, staff will coordinate with the ambulance leadership to identify outstanding PCRs and to restart billing activity, and the commission will add the billing agreement and related lease/contract issues to the next meeting agenda for formal action or referral.

The discussion did not include a final vote to end or renew any contract; commissioners limited the immediate decision to staff action and future agenda placement.

Ending: Commissioners asked ambulance leadership to return with documentation and a short action plan; staff said they would provide contact information and paperwork to assist with creating a separate billing entity and resolving the Medicare/EIN issues.