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Dare County, hospital begin steps to shrink unpaid interfacility transport gap; protocols and software fixes underway
Summary
Officials said software, billing protocols and clearer criteria for ambulance eligibility are already reducing rejected interfacility transport claims; longer-term options for funding and staffing remain under discussion.
Dare County officials and hospital leaders reported progress March 3 on reducing rejected ambulance transport claims and on drafting protocols to clarify when interfacility transports should be handled by ambulances.
The county manager said the county and hospital have been "victims of our success," as expanded hospital services and growing demand have increased interfacility transport needs.
Why it matters: interfacility transports'the ambulance rides that move a patient from one medical facility to another'are usually the hospital's operational responsibility but are often provided by county EMS crews. The county said the combined effect of complex payer rules and rising volume has left some transport costs unreimbursed, straining EMS resources needed for 911 responses.
What officials told commissioners: staff described two linked issues they are addressing. First, rejected claims and underpayment: county and hospital teams identified software integration and documentation gaps that led insurers to deny payment. Hospital and EMS staff are implementing software fixes and checklists so transports meeting documented medical-necessity protocols are coded and billed correctly. County and hospital representatives said rejected claims are already declining after those changes.
Second, a long-term resource question: commissioners were told the county currently lacks the dedicated personnel to absorb continuing growth in interfacility transports at current staffing levels without degrading 911 coverage. County and hospital staff are modeling options: the county could continue providing transports with additional funded resources, the hospital could use or contract for transport services, or a hybrid solution could be developed. Staff said they will present cost estimates and recommendations for how to fund any county role before commissioners would be asked to approve new expenditures.
Safety and staffing concerns: commissioners raised fatigue and safety questions about long-haul transports and the impact on ambulance coverage. EMS leaders said the service has increased staffed units over recent years and deploys long transports across multiple units to avoid overburdening individual crews; they described operational safeguards and said no vehicle accidents attributable to crew fatigue occurred in the presenter's nine-year tenure.
Next steps: staff said short-term billing and software fixes are in place and should reduce unreimbursed claims without action by the board. For the longer term, the hospital and county will finalize cost estimates for different delivery models and return with a proposed plan and funding options.
