The Callaway County Ambulance District received a clean audit for 2013, but board member Chuck Baker raised a concern regarding patient billing during accountant Dale Siebeneck's report at Tuesday night's meeting.
As Siebeneck, with Evers & Company, CPA's, was reviewing the district's assets, Baker made note of the Accounts Receivable-Patient line item, listed at $590,444.
"The AR seems high. To me, it should be under $200,000, but I don't know if that applies to an ambulance district," said Baker, who also is the COO at Callaway Community Hospital.
Siebeneck said a high accounts receivable balance is traditionally a "common problem" for ambulance districts - especially in Callaway County, where proximity to Interstate 70 and Highway 54 mean a high number of services provided to patients not from the area.
CCAD Director Charles Anderson said the district typically sends out a bill for services within two days of making a run. Medicare and Medicaid, he said, typically return payment "in about 14 days" with private insurance generally taking a bit longer.
"Frankly, the problem is a large number of the patients we transport don't have insurance," Anderson said.
Anderson said the district does not typically follow up on aging accounts, eventually either turning them over to a collection agency after a year or writing them off. He said the district does not get much return on bills collected by the collection agency.
Anderson said that was one reason he has been considering outsourcing the district's billing altogether - noting a billing agency would have more resources to follow up on aging accounts.
Baker asked Siebeneck what his recommendation would be regarding contracting out billing services.
"It's a hard call. I don't know that you're going to see some of those harder-to-collect ones come in. You might gain a little bit, but by the time you pay the cost ... I don't know," Siebeneck said. "I would need the numbers (before making a recommendation)."
Anderson said that ambulance services that typically see a significant gain in taking such measure s "are those that have not done a good job getting bills out, which is not a problem for us."
Anderson said it was something the district would have to consider, and that he would put together a Request For Proposals.
The rest of the audit report was business as usual, with a positive review from Siebeneck.
"You're generally doing a pretty good job of running things," Siebeneck said. "Your accounting records are in good shape. Overall it's positive."
In other business during Tuesday night's meeting, the board approved a bid from Lefty's Quality Roofing and Construction of Fulton to repair hail damage at the Fulton station on April 2.
Anderson said the district's insurance company estimated the repair costs at $25,477 and cut the district a check, minus its $5,000 deductible.
Anderson said the smoking shelter and gutters were included in that estimate, but were still functional and he did not believe it necessary to make repairs.
"Primarily what we want to get fixed is the roof and the vents," he said.
Lefty's submitted the low bid at $19,800; CoMo Premium Roofing out of Columbia submitted a bid of $19,834.64 and Premium Property Services out of Jefferson City submitted a bid of $23,532.92.
"In looking through these, and talking to different people that use these companies, (Assistant Director) Linda Ellis recommended we use Lefty's," Anderson said. "The problem with all of them is they're so busy right now it could be three or four months before it gets repaired. Lefty's said if issues come up where it needs patched and looks like it might leak, he'd come take care of that right away."
Board member Brian Schmidt said the only real difference he saw between the Lefty's and CoMo bids was that CoMo was proposing to use an ice and water shield underlay, which he said could extend the life of the work.
Ellis said she had heard the chamber of commerce had received a number of complaints about CoMo - which she speculated may be due to it being a larger company that sometimes "has outsiders coming in to subcontract."
Board member Clay Chism pointed out Lefty's had a five-year warranty versus a one-year warranty on the work from CoMo. He also said the line item for the ice and water shield was only $200.
After some discussion, the board voted to approve the Lefty's bid and request the use of the ice and water shield, with the district to pick up the difference in cost if the project goes over the amount received from insurance.
"I'd rather keep the money local," Schmidt said when he made the motion.