That money has been lost from Medicare not paying up on 50 percent of claims and a high number of non transports by Henry County EMS.

With all of the red tape that Medicare forces Emergency Medical Services to wade through, it’s no surprise that Henry County EMS is losing money like many other EMSs. Many of them are now bankrupt. However, Henry County and others have an ally who says he will work to plug a hole in the financial dam that is draining counties of their funds.

On June 12, Lt. Governor Steve Henry visited the Henry County EMS building in New Castle to talk about what he is trying to do to recover some of those costs. According to Henry, Kentucky has a 50 percent claim denial rate. The national average is about 20 percent.

“They (Medicare) kept telling us it would get better,” Henry said. “It did for a while, some money was collected. We’re concerned we’ve seen a backslide. (Medicare) may not be handling claims as they should be,” Henry said.

When EMS can’t collect a Medicare claim, the county budget has to makes up the difference. “When Medicare doesn’t pay the bill, citizens end up paying it,” Henry said.

Henry offered to try to get some denials approved and instructed Henry County EMS Director Bonnie Smith to send them to his office. But the red tapes and delays continue to mount.

“You do something wrong, and the government is all over you. They do something wrong for years and that’s okay,” Henry said.

Smith said she received a refund from Medicare for .28 cents. “Thirty-four cents to mail a .28 cent check,” Smith said.

“We’re going to watch it very closely and create as much attention to what they’re doing as possible.” Henry said. When the deficit hits, health care will get hit and services will get worse.

Henry said Medicare denies claims in the hope that Bonnie will get frustrated and quit. Some claims have to get filed twice, once with Medicare then Medicaid for the difference. It’s very difficult to get that difference on the second claim.

“The state of Kentucky ought to do their part to pay their bills.” Henry said.

Smith said that Medicare has been "pretty good" about paying costs, since the Lt. Governor and Congressman Ken Lucas have stepped in. But she has also said she stopped filing some claims because, “Medicare (says) they do not cover taking a patient to the doctor’s office,” Smith said. But, by law if someone calls 911, we have to take them Smith agreed when asked. There are cases when a patient may need to simply go to the doctor’s office and call 911.

“For many people it’s their only way to go, “Smith said. “I feel like we owe these people. They are citizens of Henry County,” Smith said. Smith said she no longer appeals to Medicare that type of claims to take patients to the doctor, because Medicare says they will not pay for it.

“Some of these little old people are on a fixed income. There is no way they can pay. And I feel like we owe them,” Smith said. “We can’t refuse them. It can add up real quick when you take them three times a week,’ she added.

An ambulance ride often costs about $160. Sometimes it can be more and sometimes it can be less, Smith said. That includes the $2.50 a mile and $15 for oxygen and other supplies.

However, according to Smith it’s not really the failure to collect on Medicare claims that is costing county taxpayers. It’s the non transports. A non transport occurs when a patient refuses to be taken to a hospital at an injury and/or accident scene.

The county still has to eat that cost, for mileage and employee’s hours and other expenses. In January there were 12, February, 10, March, 16, April, 15 and May, 18. That totals about $11,360 so far this year, if each transport averages $160.

“There’s nothing we can do. We have to respond,” Smith said.

Between Medicare claim denials and non transport costs, Kentucky’s EMSs are hurting.

The work has to continue for Henry County EMS. Smith said they’re still getting appeals from 1999. Because, when a claim is denied, the EMSs have six months to appeal, she said.

‘They (legislators) are really trying to solve the problem,” Smith said.

One way that EMS may recoup some of its costs are to raise the transport fees. The prices will go up from $105 to $252 for basic transport. That does not include any extras such as mileage. Mileage will increase from $2.50 per mile to $7.50 per mile.