Lt. Gov. Steve Henry visited with Harrison at Marshall County Hospital on Friday May 11, to offer assistance.

The problem said Henry and Harrison, is an agency called AdminaStar-Federal, who contracts with the Health Care Financing Administration (HCFA), to process Medicare claims.

For most of the state, Henry said AdminaStar would not even process up to half the claims, but through changes which have finally been made, around $4 or $5 million has been recovered out of $13 million owed the state. Most ambulance services fi1e under "Part B," if they are not hospital affiliated or hospital owned.

But for ambulance services like Marshall County's, who is affiliated with Marsha1l County Hospital and files "Part A," Harrison said claims are being processed but denied at unusually high rates with no reasons given, or reasons that are unusual: Harrison said a software glitch is keeping 511 claims in suspension for 2001, because AdminaStar cannot figure whether the ZIP code should be entered into the computer as 0000-ZIP or 00-ZIP-OO, or be right or left justified.

While bigger ambulance services are going in debt, smaller ones are going out of business. He said three of Kentucky's ambulance services in rural areas have closed because of money lost through claims denied.

"I think AdminaStar keeps their contract based on how much money they save the federal government," Henry said. Throughout the state, at least $1 million has been spent hiring additional personnel and consultants because of HCFA's inability to pay bills on time, he said.

Kentucky has the highest Medicare denial rate in the nation, closely followed by Indiana. Those two states are the only two states served by AdminaStar, Henry said. He said when he took some denied claims to Washington, nothing was wrong with more than 20 percent of them.

Henry said he worries that as ambulance services become more and more strapped, patients may have to worry about the care they receive. As a patient, I don't want to wonder whether they are going to give me another shot I need when they know it costs them $150 that will not be reimbursed," he said.

The good news, Henry said, is that things are changing. For Part B claims, AdminaStar has agreed to no longer require a doctor's signature when a nurse's will do, and Henry said they have verbally agreed to drop the same standard on Part A claims. "They are paying a lot more than they used to," Henry said, "but they still have a long way to go."