GEMT
A.P. Triton LLC©
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 Opportunities exist that allow public ambulance providers to receive
supplemental reimbursement from the Federal Government
 These programs are part of the Federal Medicaid program
 Each state participates in the Medicaid program so each state is eligible
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 Program draws down Federal Medicaid dollars to help offset the cost of providing
emergency ambulance and transport for Medicaid patients
 Two primary mechanisms for drawing down money are CPE’s and IGT’s
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 CPE’s are Certified Public Expenditures for use in Fee For Service
 Cost sharing program 50/50 split of the uncompensated cost of the service
 Entitlement program that is mandatory, is not subject to federal appropriations
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 IGT’s are Inter-Governmental Transfers
 Cost sharing program 50/50 split of the total cost of the service
 Entitlement program that is mandatory, is not subject to federal appropriations
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
Example
 Your state has 20% population of Medicaid assistance
 Your state pays average of $180 per transport
 Your FFS cost is $1,180…..your UCC is $1,000…..your CPE share is $500
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 CPE/IGT all inclusive costs can average $2,000 per transport
 Based upon a 9,000 call EMS system at 20% FFS/MC (HMO), new revenue would
exceed $1.8 million per year
 (9k x 20% = 1,800) 1,800 x $1,000 = $1,800,000.00
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 QAF ‘s are Quality Assurance Fees
 The program places an assessment (or tax) on each Medicaid transport
 The assessment is used to draw down a Federal match
 Distribution of funds creates winners and losers in reimbursement amounts
 Typically requires mandatory participation
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 9,000 calls per year @20% Medicaid rate
 Current reimbursement 1,800 x $180 = $324,000
 GEMT / IGT = $1,800,000.00
560% increase to revenue
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 Every state participates in CPE or IGT programs
 The Medicaid programs have existed for more than 30 years
 Not likely to change in the near future, even with the ACA. In fact they may expand.
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 Create enabling legislation to facilitate a State Plan Amendment SPA
 SPA creates the program that establishes the “rules” for participation
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 Providers must develop the SPA, the State will ensure it meets state regulations
 The State will present the SPA to CMS for Federal approval
 The State and Feds will only approve what is asked for (don’t ask/don’t receive)
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 All costs associated with the development of the program are applied to the cost of
service
 Participation is always voluntary
GROUND EMERGENCY MEDICAL TRANSPORT SUPPLEMENTAL
REIMBURSEMENT
 Participation is not granted unless reimbursement of shared program development is
paid to the Host Agency
 Cost of participation will never exceed the revenue received
FIRST RESPONDER FEE
TREAT AND RELEASE FEE
A.P. Triton LLC ©
FRM 2015
FRF / TRF
What is it?
• Legal, ethical, honest billing for services that are
recognized by most private insurance companies
• Is charged for all encounters that result in a patient
assessment
• Has NOTHING to do with ambulance transport
• Is not regulated by your LEMSA
FRF / TRF
What is it not?
• It is NOT a “crash tax”
• It is NOT a money grab
• It is NOT a scam
FRF / TRF
Methodology
• Average time on task E/T = 20 minutes
• Average hourly rate per unit = $150.00/hr.
• 67,200 calls/3 (20) = 22,400/hrs. on task
• 22,400 x $150.00 = $3,360,000.00
FRF / TRF
Actual reimbursements to date
• Collection rate is about 17%
• 17% collection = 11,424 billable calls
• 11,424 x $275.00 = $3,141,600.00
FRF / TRF
What is the backlash and how do we handle it?
• Since introduction in February 2012 – 67 complaints
• Most will come from senior groups – most vocal
• Explain that taxes do Not cover the full cost of
service
• Explain the cost of response and treatment of
“individuals” medical cost
FRF / TRF
What is the backlash and how do we handle it?
• Most will come from senior groups (continued)
• “Individual treatment above and beyond suppression is
costing ALL taxpayers
• Without supplemental payments the service would be
cut back or eliminated
• “Individual” service that can be covered offsets the cost
and allows continuation of medical services
• Because 20% of patient has FRF/TNT coverage it
allows us to wave the fee for those who do not
PUTTING IT ALL
TOGETHER
2010 METRO FIRE OPERATIONS
• Operated thirteen 24-hr. ambulances
• 1/3 of the engines were ALS
• EMS operating budget of $14.6 million
• Revenue $13.8 million
• Began working on GEMT
2011 OPERATIONAL CHANGES
• Converted all units including trucks to ALS
• Began feasibility study for FRF/TRF fees
• Began feasibility study for phasing out private
contractor
2012 CHANGE IN FEE STRUCTURE
• Reassessed transport fees
• Instituted FRF/TRF
• Began detailed RAS/AMA review
2013 OPERATIONAL CHANGES
• Replaced our private contractor with SRP’s
• Placed seven SRP units into service
• Instituted twelve-hour staffing on SRP units
2014 RESULTS
• Increased service coverage to 100% ALS
• Increased number of units from 13 to 24
• Increased system costs from $14 million to $24 million
2014 RESULTS
• Increased EMS revenue from $13 million to
$31,845,000 million
• GEMT / IGT revenue collected = $8.4 million
• Total EMS revenue collection FY14/15 = $40,245,000