Butkovitz Finds City Owed $50 Million in EMS Fees


Audit Date: May 9, 2012

Audit Categories

  • Performance
Controller: Alan Butkovitz

Executive Summary


For Immediate Release:
May 9, 2012

Contact: Harvey Rice
215-686-6696

Butkovitz Finds City Owed $50 Million in EMS Fees
City Controller’s EMS Billings & Collection follow-up report
reveals collection rate still only 42 percent

EMS Billings & Collection Follow-Up Report

Fire Department FY07-09 Auditor’s Report

Download Report Visuals

PHILADELPHIA – City Controller Alan Butkovitz today released a follow-up report of the Fire Department’s collection and billing process of ambulance fees that found the city is owed almost $50 million in EMS fees for fiscal year 2011.

Of the $82.5 million billed by the Fire Department for EMS user fees in FY2011, a total of $34.4 million was collected, marking a collection rate of 42 percent. In the Controller’s prior EMS billing report, the collection rate for FY2006 was 41 percent.

“The collection rate remained virtually unchanged during this five year period, leaving millions of dollars on the table and not collected,” said Butkovitz, at today’s press conference. “While there have been developments during this time to increase revenues, there is still much improvement needed.”

Since the Controller’s prior report, which was released January 2008, the City took action on some of the Controller’s previous recommendations. This included raising the fees for both Basic Life Support (BLS) and Advanced Life Support (ALS) by almost 100 percent, resulting in a $5.5 million increase in EMS Revenues in the last fiscal year. The City in February also selected a new EMS patient billing vendor.

“We’re hopefully anticipating that with the new EMS billing vendor the City will experience a significant increase in its collection rate,” said Butkovitz.

Along with the $50 million that was billed but not collected, the Controller’s follow-up report also reviewed an additional $97 million in potential revenue the Fire Department charged for services but couldn’t collect because it was either not billed or written off.

Of the $97 million in additional potential revenue, $78 million could not be collected because it was considered disallowable, either through Medicare, Medicaid or Independence Blue Cross. Under state Medicaid regulations, the city, by law is mandated to accept only the Medicaid reimbursement amounts of $200 for ALS and $120 for BLS, compared to the actual charge of $1,050 and $950, respectively.

According to Butkovitz, for every ALS run, the Fire Department can expect to receive only 19 cents on the dollar and for BLS runs, only 13 cents on the dollar.

“I strongly recommend the Administration lobby state and federal legislators to increase Medicaid and Medicare reimbursements rates,” said Butkovitz. “State Medicaid reimbursements have not increased since early 1990s.”

The remaining $19 million in additional potential revenue was considered a write-off due to inaccurate or incomplete billings. This was a result of EMS personnel failing to ask or obtain the patient’s medical insurance card; obtaining bad or incomplete information about the patient’s billing address or erroneously entering bad billing data into their mobile data transmitters.

“The Fire Department needs to study and develop a corrective action plan that will minimize write-offs due to inaccurate and incomplete billing information,” said Butkovitz.

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