Ambulance Services Billing Resolution Memorandum
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To: Diane Flagg, Chief
Emergency Medical Services
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From: John A. Yonkosky, Director .�
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Department of Revenue
Date: November 16, 1999
Subject: Ambulance services billing resolution
Attached is an executive summary and resolution to amend the service fee and charges for
ambulance transports.
The major changes area as follows:
1. Remove the 7 mile cap on in County transports;
2. Shorten the time constraints from 120 days to 90 days before an account can be
turned over to a collection agency;
3. Increase the hourly charge for 2 medic/1 ambulance from $75 per hour to $150 per
hour.
A copy of the executive summary and the resolution have been sent to the County
Attorney's Office for review.
I would like to present this to the Board of County Commissioners on December 14, 1999.
In order to make the 12/14/99 meeting, the executive summary must be signed and
returned to me no later that December 2, 1999.
These changes are initiated as a result of the LaRue study.
Please call if there are any questions.
JAY:pc
Attachments
C:/with attachments
Mike McNees,Acting Emergency Medical Services Administrator
Leo Ochs,Jr., Support Services Administrator
Teresa A. Riesen, Revenue Manager
Department of Revenue Services
EXECUTIVE SUMMARY
APPROVAL OF A RESOLUTION AMENDING THE COLLIER COUNTY
AMBULANCE SERVICE USER FEES
OBJECTIVE: Board of County Commissioners adopt the attached resolution amending
ambulance service fees in accordance with Ordinance 96-36.
CONSIDERATION: In accordance with the County's ordinance regulating ambulance
service fees and billing procedures, staff periodically prepares and presents for Board
consideration a resolution amending the fee structure and billing procedures.
Prior to September, 1994, ambulance service bills were generally submitted directly to
transportees for payment. In September of 1994, the Board approved a change in the
billing process wherein staff could accept assignment from Medicare. Accepting
Medicare assignment allowed Medicare reimbursement to be made directly to the
County. The transportee would be billed for any allowable unpaid balances (co-
insurance).
A history of rates established by Board action is as follows:
BASE MILEAGE MILEAGE CAP MILEAGE CHARGE
DATE RATE RATE IN COUNTY OUT OF COUNTY
9/24/94 $250 -0- -0- -0-
6/25/96 $302 -0- -0- -0-
10/13/98 $300 $5/mi 7 Unlimited
Proposed $300 $5/mi Unlimited Unlimited
The major change in the attached Resolution is to eliminate the 7 mile mileage cap. All
"loaded"mileage would be billed for In-County transports.
For comparison purposes, the following is provided:
TOTAL MILES GROSS COLLECTED
FY99 RATE MILES BILLED REVENUE na, 65%
Current $5/mi 180,000 100,000 $500,000 $325,000
Proposed $5/mi 180,000 180,000 $900,000 $585,000
The average "loaded" mileage is estimated to be approximately 15 miles per transport.
Therefor the average bill would be as follows:
BASE MILEAGE AVERAGE
RATE BASE RATE MILES BILL
Current NA $5/mi 7 $35
Proposed NA $5/mi 15 $75
Impact on transportees by group is anticipated as follows:
100% All transports would see an increase of$40.
38% Medicare transportees would see a co-insurance increase of$8.40.
10% Medicaid does not pay for mileage.
25% Commercial insurance carriers generally follows Medicare rules; however, the co-
insurance will increase from $-0-to $40 depending on the carrier.
20% No insurance (includes indigents) will see an increase of$40.
7% All others (Victim's Compensation; Probate; etc.) generally do not pay mileage.
100%
A second proposed change is the "stand-by" charge for special events. A "stand-by"
charge is the hourly fee to have an ambulance staffed by two (2) paramedics on location
for special events such as location filming; concerts; motor sport events; etc. The
existing "stand-by" hourly rate is $75. Staff is proposing this fee be increased to $150
per hour.
A third proposed change shortens the time billing staff must wait for bill processing. A
summary of these changes is as follows:
FROM DATE OF SERVICE
CURRENT PROPOSED
Initial bills rendered 30 days 15 days
2„d bill rendered 60 days 30 days
3`d bill rendered(past due notice) 90 days 60 days
4th bill rendered(collection agency notice) 120 days 90 days
If approved, the above time parameters will apply to all bills except for Medicaid. If the
Medicaid bill is denied,the County cannot bill the transportee.
There are no recommended changes for the interest, hardship and fee waiver provisions.
The above-listed changes were recommended as a result of a study of Collier County
ambulance billing activity. The study was conducted by LaRue Planning and
Management Services, Inc.
FISCAL IMPACT: Approval of the mileage change (no cap for In-County transports)
should increase revenues in the EMS Enterprise Fund by approximately $250,000
annually.
GROWTH MANAGEMENT IMPACT: N/A
RECOMMENDATION: Board of County Commissioners approval of Resolution
amending ambulance service user fees and authorization for the Chairperson to sign.
SUBMITTED BY: �c�4, / Date: / / / $`7
Teresa A. Riesen, Revenue Manager
Department of Revenue Services
REVIEWED BY: la_���,. ir..��1 \►r►. Date: \ (\b\g.�
Jo i, 4 Yonke_. , D irector
Depa�. ►kb-nt of Reve ue .-rvices
REVIEWED BY: Date:
Diane Flagg, Chief
Emergency Medical Services
APPROVED BY: Date:
Leo Ochs, Jr., Administrator
Support Services Division
APPROVED BY: Date:
Mike McNees, Acting Administrator
Emergency Medical Services
RESOLUTION NO. 99 -
RESOLUTION APPROVING USER FEES FOR COLLIER
COUNTY AMBULANCE SERVICES PURSUANT TO COLLIER
COUNTY ORDINANCE NO. 96 - 36; ADOPTING BILLING AND
COLLECTION PROCEDURE; PROVIDING ADJUSTMENTS AND
WAIVERS; AND APPROVING HARDSHIP CASES AND
PAYMENT PLANS
WHEREAS, Collier County Emergency Medical Services (hereinafter referred to
as "EMS") provides ambulance services to the residents and visitors of Collier County;
and
WHEREAS, the Collier County EMS operating budget is funded exclusively
through ad valorem taxes and user fees; and
WHEREAS, Collier County staff analysis of the cost for ambulance services
requires an adjustment to the user fees to properly identify current costs of services to
the residents and visitors of Collier County; and
WHEREAS, Collier County Ordinance 96 - 36 provides that the user fees for
ambulance services may be established by Resolution of the Board of County
Commissioners (hereinafter sometimes referred to as "the Board").
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA that:
SECTION ONE: EMS USER FEES
USER FEE CHARGE
A. EMS AMBULANCE TRANSPORT BASE RATE $ 300
B. EMS AMBULANCE TRANSPORT PER MILE $ 5
- IN COUNTY TRANSPORTS FOR ALL LOADED MILES
- ACTUAL LOADED MILES FOR OUT OF COUNTY
INTER FACILITY TRANSPORTS
C. SPECIAL EVENTS:
- TWO (2) MEDICS/ONE VEHICLE (PER HOUR) $ 150
- ONE (1) MEDIC/NO VEHICLE (PER HOUR) $ 40
D. COPIES OF DOCUMENTS/PER PAGE $ 1
(EXCLUDING GOVERNMENTAL AGENCIES)
E. INTEREST ON PAST DUE ACCOUNTS 1%
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SECTION TWO: BILLING AND COLLECTION PROCEDURE
The following shall be the minimum guidelines for billing and collection
procedures for ambulance service fees and charges:
A. Initial fees and charges for ambulance service(s) shall be assessed either
prior to or following the service provision, as services dynamics reasonably permit.
Unpaid fees and charges, subsequent to time of service, shall be reflected in an
accounts receivable subsidiary ledger system to be maintained by the Department of
Revenue Services.
B. An initial bill for ambulance services shall be processed in the following
manner within fifteen (15) days after service is provided.
1. The County will send an initial bill to the service recipient's or
responsible party's insurance carrier provided that appropriate
insurance information is made available to the County. The County
will accept Medicare assignment, as a participating provider, and will
wait no less than 30 days for payment if Medicare or other insurance
carrier is billed. If the claim is denied due to non-coverage, a bill will
be sent to the service recipient or responsible party.
2. The County will also send a bill to Florida Medicaid and accept
assignment if appropriate insurance information is made available to
the County by the service recipient or responsible party. The County
will wait no less than 30 days for payment if Medicaid is billed. If the
claim is denied, a bill will sent to the service recipient or responsible
party.
3. In the event the service recipient or responsible party does not have
or does not provide proof of insurance coverage, the bill for
ambulance service(s) shall be sent directly to the service recipient or
responsible party for payment. The County will wait no less than 30
days for payment.
The following will occur if payment has not been received within
above set guidelines:
a. A past due notice will be sent in accordance with the above
provisions (30 days after billing third party or Medicare, 30
2
days after billing Medicaid and 30 days after billing responsible
party or service recipient).
b. Thirty (30) days) after the first past due notice is sent, a
second past due notice will be sent.
C. After a ten (10) day grace period, the account will be sent to
the County's contracted collection agency.
C. Interest will be assessed at 1% per month on all accounts that are
either sent to the County's contracted collection agency or set up for
a payment plan (excluding hardships that adhere to County policy).
D. A reasonable and customary payment plan will be made available for
all service recipients or responsible parties. Should the service
recipient or responsible party at any time fail to meet the terms and
conditions of the payment plan, the unpaid balance shall be
administered in accordance with Section B.3 above.
E. When ambulance service bill(s), at any stage in this billing and
collection procedure, are returned because the Postal Service
cannot effectuate delivery, the County shall make a reasonable effort
to ascertain the correct mailing address. If reasonable efforts to
ascertain a correct address fail, the account(s) may be considered
for other collection alternatives.
F. Nothing contained in this section shall preclude reasonable
telephone or other appropriate contact for billing and collection
purposes, in accordance with all applicable laws.
G. Throughout the fiscal year, the Department of Revenue Services
shall review all past due accounts and report to the Board of County
Commissioners on an annual basis, of all past due accounts which
are believed to be uncollectible. The Board shall, after reviewing
these past due accounts and after finding that diligent efforts at
collection have proven unsuccessful, remove these past due
accounts from active accounts receivable in accordance with
generally accepted accounting procedures and pursuant to law by
Resolution.
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SECTION THREE: ADJUSTMENT OF EMS USER FEES
The following shall be minimum guidelines for adjustments to ambulance service
fees. Other adjustments are authorized by the Board of County Commissioners in
accordance with criteria established by the enabling Ordinance.
A. Medicare and Medicaid Adjustments
Contractual adjustments under Medicare assignment will be made in accordance with
applicable rules and regulations
B. Victim's Compensation Contractual Adjustments; Probate Adjustments
Contractual adjustments will be made in accordance with applicable rules and
regulations.
SECTION FOUR: WAIVER OF EMS USER FEE
Pursuant to Ordinance No. 96 - 36, and from the effective date of this
Resolution, user fees for EMS ambulance stand-by services for the following community
special events shall be waived as the Board finds that a valid public purpose is hereby
established in recognition of their charitable contributions to the Community: (1) Collier
County Fair; (2) Everglades Seafood Festival; (3) Senior PGA; and (4) Nuveen
Masters; (5) Collier County Public School varsity football games. Fees for other
community special events may be waived in accordance with criteria established by the
enabling Ordinance.
SECTION FIVE: HARDSHIP CASES AND PAYMENT PLANS
The Board recognizes that certain service recipients may need to be identified
and processed as hardship cases. Payment plans will be established pursuant to the
minimum guidelines set forth in this Resolution.
A. Hardship cases will be established in accordance with the State's Financial
hardship guidelines, as used by HRS-Collier County.
B. Payment plans for hardship cases will be set up on a monthly basis, with a
minimum payment of $10.00 per month. Hardship cases, placed on a payment plan will
not accrue interest or be placed into collection. Notwithstanding the foregoing, if a
service recipient has a payment plan and does not make the scheduled payments for a
period longer than two (2) months, the account will be turned over to the County's
contracted collection agency and interest will begin to accrue.
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SECTION SIX: SUPERSESSION OF RESOLUTION 98-419
This Resolution shall supersede Resolution No. 98 -419
SECTION SEVEN: ADOPTION AND EFFECTIVE DATE
This Resolution shall become effective on December 14, 1999.
PASSED AND DULY ADOPTED by the Board of County Commissioners of
Collier County, Florida, this day of , 1999.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, CLERK OF COLLIER COUNTY, FLORIDA
BY: BY:
PAMELA S. MAC'KIE, CHAIRWOMAN
Approved as to form and
legal sufficiency:
David C. Weigel
County Attorney
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