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The Texas Ambulance Services Supplemental Payment Program

The Texas Ambulance Services Supplemental Payment Program became effective in February 2009, with revisions made in August 2011, March 2012, and March 2013 that allow approved governmental ambulance services providers across Texas to receive supplemental payments associated with the cost of providing services to Medicaid beneficiaries and uninsured patients.

It is recognized that the cost of providing ambulance services to patients is very high. It is also recognized that the majority of the insurance that patients carry, or the patient’s ability to pay, does not come close to covering the cost of providing those ambulance services. Patients using Medicaid insurance typically cover only 30-40 percent of the cost of the services received, while it is significantly less for those patients who do not have insurance. When patients with Medicaid or those who do not have insurance represent 40 percent or more of your business, as is the case in Texas, it creates financial stress for an organization’s bottom line.

The Texas Ambulance Services Supplemental Payment Program, which a member of the Revenue Optimization Solutions, LLC team helped develop and implement, is designed to help providers offset the loss/write-off related to Medicaid beneficiaries and those without third-party insurance.

Why You Need Revenue Optimization Solutions, LLC

With the recent changes to the Texas Ambulance Services Supplemental Payment Program, there is great revenue potential for providers in Texas; however, with this potential comes increased complexity and risk of audit findings if the program is not implemented correctly. The program changes in 2012 and 2013 make it critical that providers have a solid understanding of the program, along with the knowledge of the latest developments coming from the Texas Health and Human Services Commission (HHSC) and the Centers for Medicare and Medicaid Services (CMS) - Revenue Optimization Solutions, LLC has that understanding and knowledge.

To optimize revenue, providers need a firm that has team members with the experience of working with fire departments and EMS agencies in Texas on program implementations and cost reporting, and that has the knowledge and experience working with Medicaid agencies at the state and federal levels. The program in Texas will not be as easy to implement as some may imply, and Revenue Optimization Solutions, LLC can provide the experience you need to optimize revenue and address some of the unique challenges that you will face during implementation:

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New Rules Present Cost Identification and Cost Allocation Problems

New reporting requirements enacted in March 2013 make for a more difficult cost finding and reporting process. For example, the use of paramedics or emergency medical technicians on fire apparatus for first responder purposes poses challenges in identifying eligible Medicaid and uninsured costs. In addition, the challenge of determining the costs associated with transport may seem straightforward, but new rules make that determination much more complex.

The experience of Revenue Optimization Solutions, LLC staff working in Texas and around the country with all types of ambulance service providers on cost accounting and cost allocation methodologies will be invaluable to you as you implement this program.

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The Ambulance Services Supplemental Payment Program is New

With the changes in the program rules over the last several years, there is great risk as well as great opportunity for providers participating in this program. It will be imperative for providers to have a firm that understands the uniqueness of a fire-based vs. third service vs. special use district vs. an authority type provider; the differing medical service delivery models; the cost structures differences of various providers; and how to optimize revenue based on your unique characteristics.

Revenue Optimization Solutions, LLC staff have unsurpassed experience working with myriad ambulance service provider types in Texas, and it will be extremely beneficial to have that experience and knowledge to present optimal allowable methodologies to HHSC during the approval process to maximize revenues and mitigate audit risk.

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Ambulance Services Supplemental Payment Program Approvals Are Complex

The approval process as part of the Ambulance Services Supplemental Payment Program can be cumbersome and protracted. Understanding how to handle the HHSC questions, response periods, and requests for additional information, for example, is critical for expeditious approval.

Staff of Revenue Optimization Solutions, LLC have been working with ambulance services providers in Texas for seven years, and this affords ambulance services providers the knowledge necessary to navigate the HHSC approval processes. Revenue Optimization Solutions, LLC staff know with whom to work with within HHSC to get answers quickly and to overcome hurdles faced during the approval process. Revenue Optimization Solutions, LLC staff experience working with other providers in Texas and in navigating through the approval process will also be an invaluable resource during the approval process. Revenue Optimization Solutions, LLC understands the kind of information HHSC is looking for and how to expedite the approval process.

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Reluctance to Incur Additional State Expense as Part of the Supplemental Payment Program Limits Revenue Potential

The Ambulance Services Supplemental Payment Program has in place certain methodologies that maintain budget neutrality at the State level, and because of that, the program limits the revenue potential to ambulance services providers. Because of this fiscally conservative position, it is important that ambulance service providers utilize a firm that is versed in the multitude of approaches within a cost-based, or cost-to-charge, settlement methodology to optimize cost identification and maximize revenue under the current model.