Piners Ambulance needs cash from government

Napa Valley Register

Piner's Ambulance employees are among the first to respond to local medical emergencies, but now the company is dealing with a crisis of its own.

A two-month-long gap in Medicare payments to Piner's recently prompted the ambulance company's owners to take drastic measures. In an unprecedented move, the husband-and-wife team is borrowing money against its own home to meet payroll costs, according to Jeremy Piner, operations manager at Piner's.

“I have obligations to make sure that my employees get paid for their work, whether I get paid or not,” said Gary Piner, who co-owns the company with his wife, Starr.

Jeremy Piner said the company receives about 53 percent of its income from Medicare payments, adding that the enterprise will be unable to weather mounting backlogged claims for more than a few months. At this point, he said, Piner's is owed about $1 million in Medicare claims.

If you ask Piner's and another area ambulance provider, the trouble started when the federal government switched Medicare billing companies â€" agencies that process patient claims dictating Medicare payments. The change happened in early October, when the government awarded a contract to South Carolina-based Palmetto GBA, Jeremy Piner said, adding that he believes the previous company, National Heritage Insurance Company, was outbidded for the job.

Medic Ambulance of Solano County, which is also served by Palmetto, is having similar trouble recovering its due share of Medicare claims, according to Kristi Mendez, the company's billing office manager. The company is owed roughly $1 million in unpaid Medicare reimbursements, she said.

“It's about two to three months since we've received any money from Medicare because of the transition. ... As far as Piner's is concerned, we're definitely in the same boat. We're backlogged for money, that's for sure,” she said.

But not all Palmetto clients are having the same trouble, according to Jeff Davis, communications manager at St. Helena Hospital.

“We are submitting our Medicare claims through Palmetto GBA,” Davis said in an e-mail. “The transition from NHIC to Palmetto GBA has been fairly smooth for us.”

Although Piner's experience with Palmetto is much different, Gary Piner said Napa County residents are not in immediate danger of losing ambulance services partly because Charter Oak Bank has increased the company's line of credit at a time when many banks are hesitant to extend loans at all.

As head of the 62-year-old business that provides about 35 ambulance calls daily, Piner said he also enlisted the help of Rep. Mike Thompson, D-St. Helena, who contacted Palmetto on the behalf of Piner's Ambulance.

“We decided we would call him and see if there was something he could do because this is basically a federal issue, a Medicare issue,” Piner said, adding that the effort yielded a promise from Palmetto to pay Piner's for the majority of the backlogged claims by about Dec. 1.

“Our Medicare providers deserve to be paid promptly for their services,” Thompson said in a statement. “To expect Piner Ambulance â€" the only emergency medical service provider in Napa County â€" to wait on $700,000 worth of payments for 1,400 unreimbursed calls is inexcusable. ... But this is not a problem that is isolated to Napa. I've met with the head of Medicare to discuss this problem and will continue to work for systemic changes to resolve this issue.”

Torris Smith, an associate regulatory administrator for financial management for the Centers for Medicare & Medicaid Services â€" the agency that holds the contract with Palmetto â€" said Wednesday that Piner's should have received the bulk of their overdue funds Thursday.

“I'll tell you right now as soon as I became aware of this situation, I contacted Piner's and spoke to (Piner's general manager) Stewart Slipiec. ... Palmetto has actually overnighted him a check of 70 percent of (the) claims that were already in the system,” he said. “They've already identified the solution to his provider enrollment issues.”

Smith said he did not know whether NHIC was outbidded by Palmetto, adding that Palmetto will have any remaining issues with Piner's cleared up by Dec. 31.

“We're working closely with the California Medical Association and physicians' groups to improve the (overall) situation,” he said.

A Register reporter's first call to Palmetto on Wednesday was met with a recorded voice announcing at least a 30-minute wait time to speak to a representative. During a second call, a Palmetto customer service representative said any questions must be addressed to the Centers for Medicare & Medicaid Services.

“(This is) unheard of where I come from. ... It's been a rather scary time considering that Medicare is half of our business and they're not paying us,” Gary Piner said. “I as a business guy cannot afford to lose 50 percent of my income for very long.”

Piner added that many area physicians are experiencing similar Medicare reimbursement issues with Palmetto.

“I would really like this not to be all about Piner's because the physicians are in the same boat as we are. ... We're not at risk at this point. I still have plenty of assets and our bank is very happy to help out,” Piner said.