But recently the shoe has been on the other foot.
Sullivan County Accounts and Budgets Director Larry Bailey said Thursday that his office has been receiving calls from local businesses seeking payment for past-due bills owed by the county’s emergency medical service, which responds to 9-1-1 calls countywide.
Bailey said that as he spoke — at a hastily called meeting of the county’s budget committee, in a backroom of the historic Sullivan County Courthouse after a monthly work session of the full Sullivan County Commission — more than $60,000 in unpaid bills owed by the EMS lay on a desk in his office.
That, coupled with his office’s having just made payroll for EMS employees for the most recent pay period, left the service about $79,000 in the red, Bailey said.
He asked the committee to authorize his office to immediately transfer the roughly $300,000 balance of capital funding included in this year’s county budget for the EMS, to cover its operational costs.
The group did so, with only Commissioner Mark Vance voting “no.”
Vance said that money was only added to the EMS budget to pay for much-needed ambulances.
Bailey said replacing worn-out ambulances won’t do much good if you can’t pay the emergency personnel to run calls — and hopes are that the money transfer is a temporary situation until another solution is found for revenue problems at the EMS.
EMS Director Gary Mayes said revenue has been on a steady decline in recent years due to changes in reimbursement guidelines by Medicare and by a shift toward more and more patients being “self-pay” because of much higher deductibles.
Mayes said the problem is not unique to Sullivan County EMS, but is pervasive among ambulance services — both public and private — across not only Northeast Tennessee, but nationwide.
While the EMS would ideally like to have 65 days worth of “cash on hand,“ it now operates with only about four days worth of cash on hand, Mayes said.
Of particular harm to Sullivan County EMS’s revenue stream, Mayes said: a push from those reviewing Medicare payments to refuse payment for calls billed as ALS (advanced life support) when they determine the call should have been coded BLS (basic life support).
Mayes said Sullivan County EMS runs 21,000 calls per year.
Medicare has been refusing to pay about 400 per quarter, or 1,200 per year, based on the ALS/BLS coding, Mayes said.
As for “self-pay” patients, the rate of return makes those calls fall vastly below the EMS’s $216 break-even point, Mayes said.
Vance questioned Mayes on the EMS’s use of a third-party, private-business, Paducah, Kentucky-based company to do all the agency’s billing for the past four years.
Vance said the EMS is spending about $250,000 per year on that company and he thinks it would be better to go back to doing the billing “in-house.”
Mayes said that absolutely would cost the EMS more money than paying the company in Paducah, which provides everything — computers, software, personnel, postage — to provide billing.
Vance asked about the use of a collections agency.
Mayes said the billing company sends a patient three bills and then the account is turned over to a collections agency.
But Sullivan County has not, historically, taken patients to court over the bills, most of which run between $600 and $800, Mayes said.