BELMONT — This town's Fire Department may be the first in New Hampshire to switch its ambulance-run billing company from Comstar to Enhanced Management, Inc. a limited liability company based in Pennsylvania.
As part of the switch, selectmen also voted reluctantly to "write off" as noncollectable, $180,898.22 in past due bills — an amount that has been accumulating for years.
As it stands now, Belmont, like most communities in New Hampshire, use Comstar — a Mass.-based company that subcontracts billing for ambulance service in a community. The billing rate is set by the individual community and those rates are typically based on Medicare and Medicaid payment schedules.
Fire Chief Dave Parenti and Administrator Jeanne Beaudin told selectmen on Monday that their recommendation to switch billing providers stems from what they consider a chronically low collection rate of about 67-percent — meaning Comstar collects 67-percent of what the town is owed in ambulance fees.
Comstar has been charging Belmont 5 percent of the amount collected — a fee that was 6.5-percent, according to Parenti, but which was negotiated down after he became chief five years ago.
The new billing company, Enhanced, charges 8 percent but has told administrators that with its enhanced technology to find and bill many of the people who are delinquent, the amount it collects annually will offset the $5,081 in additional fees the town can expect to pay.
To do this, Enhanced would have to increase the collection rate of 67 percent to 69 percent. Other local communities have said that Comstar collects on average between 67- and 70-percent of ambulance fees billed.
Up until now, Belmont selectmen have been reluctant to "write off" the ever accumulating amount of money that goes uncollected by the town for ambulance billings. A few months ago, Parenti reported that Comstar uses a secondary bill collector called FFR for the so-called "dead beat" accounts but its collections rates are miniscule at best.
One of the key problems, identified by Parenti in previous meetings, is that Comstar bills the insurer for the money but then often sends the claim check to the patient.
Enhanced has said it would send bills to insurers as well as notices to customers reminding them that they are responsible for the balance not paid by their insurer. He added that Enhance will work with customers to set up payment accounts and will accept credit cards — something Comstar doesn't do.
Parenti estimates that on average each ambulance run costs about $1,100 and between $400 and $500 of it is reimbursable by Medicaid or Medicare. He said the collection percentages from private insurers is much higher. The balance remains the obligation of the patient.
Selectman Jon Pike agreed with the new approach but asked Parenti to keep the board up-to-date on the delinquent billings and not let them grow to the point where they reach nearly $200,000.
Parenti reminded Pike that he was the one who first brought the uncollectables to the board's attention when he first came to Belmont but the board then was averse to writing off the past dues as bad debt.
With Monday's vote, Parenti said he will begin with Enhance after giving Comstar appropriate notice.
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