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Committee flags ambulance and medical center revenue questions amid budget review
Summary
Committee members pressed for clearer financial statements after staff reported changes in ambulance billing, six months of added transport revenue, and a large swing in the medical center's gross billing; they requested legible, itemized revenue and write-off documentation before approving appropriations.
Lincoln budget committee members spent a substantial portion of the meeting probing the ambulance provider and medical center financials after staff presented a budget worksheet the committee found difficult to read.
S2 raised the statute-driven change in ambulance billing: “They've passed the law that the insurers now have to pay 325% of what the Medicare and Medicaid reimbursement is,” a point the committee treated as a planning assumption but asked staff to verify with the statute. S4 and others said the change — combined with additional transport activity — appeared to drive a large uptick in gross billing and offsetting revenue entries in the medical center's report.
The committee noted a discrepancy between printed budgets and the clearer expenditure report S4 subsequently said she would supply. S4 described gross billing figures (as printed on page 6) and explained that the medical center added six months of transport revenue into the current-year projection; the committee asked for a clean profit-and-loss-style statement because the submitted copy was too small and blurred to read reliably.
Members flagged mandated Medicare write-offs and bad-debt assumptions that materially affect net revenue. S2 and S3 asked staff to produce an itemized revenue and offset schedule (gross billing, bad debt, mandated write-offs, payer mix, and transport revenue) so the committee can present a defensible recommendation to the select board and town meeting.
The committee did not take any final budget votes related to the ambulance or medical center; S4 committed to scanning and circulating legible pages and to provide a breakdown of Medicare write-offs and the transport revenue assumptions prior to the next meeting.
