Published June 21 in the Barbourville Mountain Advocate

Medicare payment helps Knox County EMS but still not enough

By MARILYNN BRITTAIN
Barbourville Mountain Advocate

BARBOURVILLE — Although Knox County EMS recently received a Medicare payment, it's only a drop in the bucket compared to the half million in claims that's still being processed.

Medicare is making payments to Kentucky's ambulance providers, but some, such as Knox County EMS, are still far behind some others, according to officials.

EMS Chief Joe Bradshaw said they received a check for $27,000 on Friday from Medicare but there are still $500,000 in bills that are still being processed.

The $27,000 was more than the service received in May and more than it received in recent months, he said.

Before the problems with Medicare began last year, Knox County EMS would receive between $50,000 and $60,000 monthly from Medicare, he said. The problems came to light when AdminaStar Federal , the contracted processing agent, started denying legitimate claims and denying almost 50 percent of all submitted ambulance runs. Lt. Gov. Steve Henry and his office have been investigating AdminaStar for several months. A report could be issued as early as this week, Bradshaw said.

Henry's office and Bradshaw have noticed a decline in reimbursement payments since January when the problems surfaced. An initial meeting with AdminaStar officials showed a backlog in processing claims as the main reason for the problems.

However, the problems do not appear to be consistent across the state. Bradshaw said he spoke recently with EMS officials in Scott County and they said they are consistently receiving their payments on time, but there is Marion County who is not getting their checks and is in bad shape.

Some of the problem could be that Knox County has a high Medicare population. For the majority of them, Medicare is their primary insurance. If Medicare won't pay the claim then, Medicare or other insurance companies won't pay either, he said.

The problems with Medicare forced Mountain Lifeline, in Whitely County, to close in February with hundreds of thousands of dollars owed by Medicare.

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