Fentress Ambulance Raise Rates To Maximize Medicare Payout

The Fentress County Ambulance Service raising its rates to match the charges allowed by Medicare.

Ambulance Service Director Tony Maxfield said there were several rates they needed to increase in order to maximize what they get paid through Medicare, Medicaid and private insurance. Maxfield said he consulted with the county’s billing company who suggested the rate change.

“The goal is for us to be able to collect as much as Medicare will pay us,” Maxfield said. “In order to do that, we have to charge over the allowable rate. If we just charge what they’re going to give us then we’ll be below.”

Maxfield said this is a common practice among ambulance services. He said citizens should not see much of a change in what they have to pay out of pocket for using ambulance services.

“Medicare does not pay 100 percent of the bill,” Maxfield said. “They pay 80 percent, of that 80 percent, the 20 percent is either co-pay or supplemental insurance.”

Most emergency service providers set rates at or near the 150 percent of Medicare’s reimbursement rates. Maxfield said the rate change will also put the ambulance rates in a similar place to surrounding counties.

“Some things aren’t changing much at all, while other categories are going to change quite a bit,” Maxfield said. “Right now, we’re well below the average for what an ambulance service charges in Tennessee.”

Maxfield said the ambulance service examines rates change often. He said the changes come from a broad spectrum of categories.

“This isn’t something we’ve not been done before,” Maxfield said. “At least once a year you have to look at the rates and raise or lower them depending on Medicare’s rates. Our mileage rate stayed about the same.”

Fentress County Commissioners approved the rate change this week. Maxfield said the nuts and bolts work of setting these rates requires a lot of number crunching.

“It’s kind of confusing,” Maxfield said. “There’s a lot of formulas that come into play when you’re trying to set a rate. It’d take about a half day and a pencil and paper and calculator for me to show you how it works.”