BOISE — Ada County Paramedics is seeing a steady increase in calls paid for by Medicare or Medicaid, which means the county’s emergency medical service provider is losing out on revenue it previously collected.

“One of the things that we’ve seen occurring over the years is the population in general is aging,” said Darby Weston, director of Ada County Paramedics.

That means the number of calls ambulances respond to across the county are increasingly funded by Medicare.

“So in 2002 Medicare introduced a rule that said you cannot balance bill a patient,” Weston said. That means any costs not covered by Medicare cannot be billed to a patient. They are written off, he said. The same model is applied to Medicaid payments.

Ada County Paramedics funding totals $19.1 million, roughly $10.6 million of which is from user costs.

Medicare and Medicaid provide only a portion of the cost of an ambulance ride.

Ada County Paramedics classifies ambulance rides under Advanced Life Support and Basic Life Support.

The average cost for advanced services are $980 per ride plus mileage. The average cost for basic services is $660 plus mileage. Mileage costs are billed at $14.32, according to numbers provided by Ada County Paramedics.

Reimbursement rates under Medicare are $343.88 for basic services and $408.36 for advanced services. Mileage is reimbursed at a rate of $7.55 per mile, according to the numbers.

Medicaid reimburses less than Medicare, with a rate of $303.64 per ride for basic services, $360.58 per ride for advanced services and a mileage reimbursement rate of $6.63 per mile.

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“The patients that we are seeing have shifted to a higher percentage of our patient population at the 65-plus age range, which fall within the Medicare group,” according to Weston. “In 2010, 37.8% of our patient population was in this range. In 2018, that number had increased to 42.1%.”

The amount not collected is simply lost revenue, Weston said.

Ada County Paramedics lost roughly $7 million in 2018 between Medicare and Medicaid payments, Weston said.

In 2010, Medicare payments made up 3% of Ada County Paramedics’ revenue. In 2018, that’s now up to 14%, Weston said.

“It’s purely lost revenue because it is prohibitive to bill for it,” he said.

This puts more stress on other revenue streams for the county EMS services.

“It is something that we’ve just managed over time because there are no options available,” Weston said. “What it does is simply shift the cost.”

Weston said that planned calls such as transporting a patient are easier to plan and budget for, but the real stress is emergency calls.

“Emergency responses happen when they happen,” he said.

Xavier Ward covers Ada County for The Idaho Press. You can follow him on Twitter at @XavierAWard.

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