Compromise reached with Medicare | NevadaAppeal.com

Compromise reached with Medicare

Amanda Hammon

Carson City’s pending battle with Medicare was put on hold as their disagreement took a cordial turn Thursday, leading to a $147,000 refund.

The Carson City Ambulance Service received a $140,000 loan from the city’s general fund after a Medicare audit cost the service about $147,000.

Medicare ordered an audit by a private company of Carson’s 1,600 Medicare ambulance runs from mid-1995 to mid-1996. Transamerica Occidental Life Insurance Co. reviewed 80 cases which Medicare had already paid and determined Carson City shouldn’t have been reimbursed for services in 51 of the cases.

The city decided to appeal Medicare’s decision, asking for a refund. City supervisors last week approved $25,000 for a lawyer specializing in Medicare law to help appeal the decision.

U.S. Sen. Richard Bryan’s office intervened, however, and brought both sides of the conflict together to work on a compromise outside of the courtroom.

“The greatest part of the problem was communication,” said Tom Baker, rural director for Bryan. “There was no one there who didn’t want to solve the problem.”

Ambulance Battalion Chief Vincent Pirozzi said the city wasn’t dropping its case against Medicare, but said the group meeting put the appeal on hold.

Medicare and Transamerica representatives met with city staff including Pirozzi, Fire Department Chief Lou Buckley, Deputy District Attorney Melanie Bruketta and City Manager John Berkich as well as a teleconference with the city’s Medicare attorney in California.

Pirozzi said Medicare representatives agreed to overturn their decision and refund the city’s $147,000 up front. They also agreed to a second review of the cases in light of some of the circumstances the ambulance service works under.

In return the city put its appeal on hold and gets to go over each case with Transamerica and Medicare representatives. If Carson City still doesn’t agree with Medicare’s decision, the option to appeal is still available, Pirozzi said.

The Carson City ambulance service gives advanced life support care by paramedics. Pirozzi said in a previous interview that Medicare was trying to dictate the level of service given by the service.

According to city records, Transamerica argued in its audit that documentation didn’t explain why a woman in cardiac arrest needed an ambulance. Another case points to a patient nearly in a coma and states that the patient could have been transported by other means.

“We’re required to use certain protocols and they agreed that this was an issue that needs to be addressed,” Pirozzi said.

Pirozzi said the meeting went “much better than we ever anticipated.”

“It was a very productive meeting with actual Medicare people,” Pirozzi said. “At least now we have real people to sit down and talk to. And we’ll have a chance to plead our case directly to the carrier.”

Pirozzi also said the Medicare representatives also gave him some tips on on how to better word billing narratives in the future.

“That’s what we wanted all along, to know what the rules are,” Pirozzi said.