Ambulance Administrative Oversight Committee

City of Roswell Ambulance Administrative Oversight Committee Minutes City Hall Mayor’s Conference Room April 17, 2018 Members Present: Devin Graham, Fire Chief, Bill Williams, Chaves County Fire Services, Mike Mathews, Public Safety Director, Jeanine Best, Councilor, Alberto Vargas for Rhonda Rauch, Lovelace Hospital, Chris Archuleta, Superior Ambulance via phone Members Absent: Shawna Shilaikis, ENMMC Representative Others Present: Eric Mann, EMS Chief 1. Call to Order- Meeting called to order at 1:32 p.m. by Chief Devin Graham 2. Approval of Minutes-Mike Mathews moved to approve the agenda and minutes from the January 16, 2018 meeting, Bill Williams second the motion. Voice vote was taken and approved 7-0. 3. Superior Report-Mr. Archuleta discussed the summary of response operation data report. Call volume, 911 calls, facility transports, collections and Bariatric status were discussed.  The 2018 volume report is down 9% compared to 2017, request for services were down but transport is up so it is averaging out. All 911 calls seem consistent with facility transports down and back up  Out of town transports, no data was available  Cancelled facility transports are primarily re-scheduled or are cancelled due to not being medically necessary, or transported by other means  The 911 transports to the hospitals are consistent, with Regional receiving about 30% of all  Increase in self pay and Medicaid, seems to be a decrease in the first quarter on collections  Billable’s are going out in a timely manner but the insurance seem to be denying many transports. Medicare Advantage transports are being denied, making a second billing necessary. This is making it difficult on collections  Speaking to others, being denied seems to be happening nationally and requiring a claim to be submitted up to four times. The average seems to be 50% approved and 50% denied  Receivables are down by a couple percent versus the usual 50%   Several carriers are having the same collection issues, and Superior’s legal team is working on it. It seems in order to pay the claim they are wanting documentation to prove it was medically necessary  CMS (Medicare) are doing audits they are calling education audits, there were 50 of Superior claims pulled and it showed 20 were denied and deemed not medically necessary. Superior has filed an appeal, we are aware that we have the documents showing these were medically necessary. Currently Superior is waiting on the denial results. The first appeal is sent to Novacost to an appeal representative within CMS and are either upheld or reversed. If a second appeal is necessary, it will then be sent to MAC(arbitrator) at regional along with any documentation. At that point, it is either denied or reversed. Normally it never goes beyond the second appeal, if it is required, they will file the third appeal only due to the fact that they believe all documentation held is substantiated by the transfer  Blue Cross Blue Shield is currently denying all claims making Superior go through the motions. Their legal team is currently working with Medicare to intervene and get involved 4. Staffing Report- Currently, they are down a couple of Paramedics and are working on staffing for out of town more frequently. They do have a few applicants and a few others starting soon. Three employees are going to be Paramedics, over all pointing to positive on staffing 5. Bariatric Capabilities Update- All kits have been installed on every ambulance; all are operational on the 911 ambulance as well as one 911 transfer unit. All four 911 trucks have had a wench kit installed. Two gurney’s are currently being utilized for that purpose, and are located at the Country Club base location. Supervisors will take the gurney, wench and ramp when needed. They will be attached to the unit until on scene 6. Four Wheel Drive Update-Southwest is constructing a couple more units; it is now a matter of completion to review and complete purchase. If it is what is needed and purchased, they will be kept here in Roswell. Both will be used for Torrance and Roswell with a plan being implemented to operate not only in season, but also off-season. Contract agreement between City of Roswell Fire Dept. and Superior was addressed regarding the all season use issue. 7. Management Change-In early March, management changed to have one lead manager to be accountable for all operations. All three will remain making Tamara the lead manager so anything significant will go through her. Operation flow is the only major change. 8. Fall Accreditation- Superior is still on target for their goal of being accredited. With accreditation, a movement in Congress will allow CMS to look at accreditation, and those will receive reimbursement at 80% the current rate if approved Public Comment-No public comment Adjournment Meeting was adjourned at 2:30 p.m. by Chief Devin Graham. The next general meeting will be at 1:30 p.m. on July 17, 2018, at City Hall Mayor’s Conference Room