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Minutes 11/13/1996 EMERGENCY MEDICAL SERVICE ADVISORY COUNCIL P (EMSAC) INFORMAL MINUTES November 13, 1996 3:00 P.M. EMERGENCY MEDICAL SERVICES HEALTH BUILDING 3301 East Tamiami Trail Council Palma Fuson Excused Members: Members: Roger Evans Fay Biles Mike Davis J.P. Gunther-Mohr Rhona Saunders Gary Young Bob Schank Bob Laird Frank Davis for Sheldon Reed Others: Theresa Reisen Unexcused members: Tim Smith Jeff Page John Yonkosky Diane B. Flagg Leo Ochs Jorge Aguilera Juan Ortega Barbara Brown The regular monthly meeting of the Collier County EMSAC committee was called to order at 3:00 p.m. on Wednesday, November 13, 1996 by Bob Laird, Chairman. Chairman Laird would like for the October minutes to reflect the following change under the topic of Complaint Process. The second sentence says Bob Laird and Gary are not interested in reviewing the departments complaints. It should read Bob Laird and Gary are not interested in reviewing the departments fees, not complaints as written. The minutes of the November 13 meeting were then approved. Chairman Laird commented on the attendance policy. If it is impossible for someone to attend a meeting they should call the EMS Secretary and let her know. BILLING DISCUSSION John Yonkosky, Director of the Department of Revenue, handed out a brochure on the comparison criteria for the ambulance billing. Bob Laird would also like to let everyone know the attendance guidelines will be • enforced. If you cannot make a meeting it is your responsibility to call the EMS Secretary and let her know you cannot be in attendance. Meeting adjourned. The report encompassed the following three areas - Collection Percentage and how it is being calculated, Service Dynamics and what services are being provided, and Cost - start up and capital. Collier County has historically used a percentage of cash collections to gross billings. The Department of Revenue percentage for 96 was 83%, for 97 the budget is for 85%. FY 1996 as a % of net billing was 87%. Lee EMS for FY96 was 89%. 89% is a net billing. Net billing % calculations reduces gross billing by contractual adjustment. Accrual comparisons and accounting methods are not used in either Lee or Collier Counties. Collier County has been using gross figures for collection statistics where Ambulance Billing of Ft. Myers uses net after adjustments in Lee County . In the past Collier County only billed individuals and not insurance companies. September 27, 1994 the billing system went to third party billing. 1995 was not a good year, going through a learning period. In 1996 Revenue Services did the billing and they received 83% of moneys billed. For 1997 the Commissioners have set the budget at $4,050,000. To make an accurate comparison accrual bases should be used. John would like to be able to provide a date of service bases for referral to the board. Ambulance Billing of Ft. Myers average for percentage of collections from October to September, 1996 was 89% but this was based on net billings to cash collections. Collier Counties was 87%. The difference is identified in hardships being written off in Lee County and not being written off in Collier, EMScan transmission, patient signatures, patient demographics, ALS/BLS billing and mileage billing, cost of collection and 31d party insurance. Lee County receives $5.00 for report request, & Collier County receives $2.00 for each report request, John is looking into increasing the fee for Collier County. John went over the startup and monitoring cost between the two companies. 1996 revenue was $2,647,393 and cost were $193,815 for a 7.3%, projected for 1997 is $3,450,000. with cost $175,000 for a 5.1%. If they take the capital outlay out of $23,900 for software then the percentage for 96 would be 6.4%. Rhona Saunders stated she felt John has done a terrific job in turning the Revenue Services around and felt they no longer needed to look at an outside agency. Roger Evans stated privatization is not always the answer and he felt John was doing a good job. Mike Davis felt the DOR was doing a good job and would like to receive updates. He questioned the special events, but John stated they will all be received it was a matter of billing in one month and the receivables coming in at a later date. Roger Evans made a motion that a statement be sent to the Board of Commissioners that the EMSAC committee is recommending, after careful study analysis, to retain the Department of Revenue for the ambulance billing. • EMS ACTIVITIES - Jeff Page On the 18th of November the three man concept will begin in the City of Naples. This will be in addition to Station 15 which will be housed at City Fire Station #2. Our Medic #1 Station by Naples Community Hospital will be relocating to City Fire Station #1 on Eighth Street. The MOU is done with the City of Naples and Marco. Fay Biles stated they are still receiving complaints on Marco in reference to three engines going to a call with the police and ambulance. Jeff said they are working on a revision of the original agreement do to the staffing levels this had to be revised. Frank Davis, a representative of the City of Naples, said on a fire alarm they are sending the first engine and the first rescue truck that accompanies that engine with lights and siren, the rest of the equipment goes without lights and siren just in case the fire alarm turns out to be something bigger. EMS has also moved into fire station #23 on 951 and for now we are there from 9:00 AM to 6:00 PM then they go back to station #9. A lease agreement is being worked on so EMS can build an actual station in one of the bays. Mike Davis commented on an exchange team from England that visited helicopter operations and one of the stations. It was very informative and would recommend any of the members to do this. Bob Laird suggested they also call and make arrangements to ride with a supervisor. OLD BUSINESS Bob Laird has a fax from Sharon Hanlon asking about the task force that was to go to Jacksonville to meet with Medicare reference increasing the base rate of the billing process. Rhona said they never went to Jacksonville however; there were several conference call meetings with Medicare from John Yonkosky office. It was concluded that a lot of questions would be raise if we asked for a special exception. Diane felt initially that asking for this special exception would work. but the committee's conclusion, and Diane agreed, that they did not want to raise any questions or pull an audit and they would leave things alone and catch up next year. Jeff let everyone know that Medicare will be coming down, not to do an audit, but to go over the requirements they need. Now routine transports and response generate a Medical Necessity Form to be filled out. They want to explain to the paramedics why this form is needed and what information they want. Bob Laird also brought up the By-laws and stated they needed to be approved. The committee would like the CHSI spelled out to say Collier Health Services, Inc. They would like for Diane to follow up with the attorneys on these corrections and the approval. APR-3E-1945 13:41 FROM COLLIER COUNTY ATTORNEY TO 7754454 P.1 cusg_orERAT1OHS MANUAL CHATTER P-8, SEe✓;I;Ott_;z,,:PAGE 7 months. 3. All CIR forme shall hp reviewed by ea supervienr•, Agent, or administrator, within the ENS deiartment, signed And dated by all parties revipvins.. 4. ENS piermnnn e 1 hand 1. i nu CUR complaints Abell be given specific direct.I nn on hnw to prode*s comp)c 1 nt.,4 to r►r more uniformity. S. fn >a quarterly basis, the EMS department 4vt 1 1. report orally or in writing to the EMSAC on tho number of e;1 R forme; filed during that time period, the nature of the complaint, and the resolution if applicable. The CIR forme shell be made available to EMSAC should a need arise or A request be. made. Patient names will be deleted to assure confidentiality, or consent will be given by the patient authorizing releemse of the information. 6. All complainants will be notified of their right to an appeal before the EMSAC, should they be dissatisfied with the outcome suggested by EMS. 7. Al]. appeals to EMSAC must be in writing with a copy of the CIR attached, and a consent form signed by the patient, or authorized agent, to release ase information to EMSAC. S. The appeal deadline to EMSAC is not to exceed 60 daye from the date of the EMS decision. c Cr an 47:7 soz - - _ '.r.e�T7 en f D all aspects of EMS in o ' . MSAC set3��ei3 study And (J" tin= ppor unities and problems associated with ovik PIPR-E1B-1996 13:42 FROM COLLlER COUNTY qTTCIRNEY TO ��4 P.11 ~V1'�X �9n �o�vv ��z 013 774 6420 ^ Ripon/Don n* i3:00 tin $13 774 6420 v�w� BRmn^ COq��r 3��EROo�mC� m��r�ha* m4mn�rIcgO �m�� COMPIIRR itit0OzArriO4 ��&��_~^-_�_--' n�v��-__.~.---�-' --� -_~__-______ oxom�:_~~--~.__ KAV�� CA%JAW�: ~_______�_______~___ PRA8°E4 FOR CA.111-.1 __~~_______________________ �0��IRNT ^r'��.~______' _�� __� __~-. P,�vy�n0� �»��r�_ _____ __�__ __ Mr:liner wami(xr''-______~ ;__--_-_'--____._--_~' �� U�� n�«m^��;_- . F�V�TEK ACTION RI�� TROD ACTION PRQUKnmOn�______-- ___ _ _ -` --- 1/2COMwOuwLAT1 pmS/ACT7ONS TAmumm• u_�-_--- -------'----- ---- -' '---_' _ __'' -_-_-_-_ - --'~~-_--- -------~------- -�--' �� RESOIVE:I) 1.1A7.7.3 APV/VXD ok APWTALIED __ `�� g�� ' '-�-'_~____-_--- tvd RI*^u °, ~'--_' TOTAL P.11