Agenda 03/22/2016 Item #16E 1 Proposed Agenda Changes
Board of County Commissioners Meeting
March 22, 2016
Move Item 16D1 to Item 11G: Recommendation to award a Change Order to Contract No. 14-
6338 in the amount of$104,200 to Victor J.Latavish Architect,PA to include additional
architectural design,engineering for sitework, and pool design for the Eagle Lakes Community
Park Pool and authorize the Chair to execute the Change Order. (Commissioner Taylor's request)
Move Item 16E1 to Item 11H: Recommendation to adopt a resolution authorizing the
removal of 7,608 ambulance service accounts and their respective uncollectible accounts
receivable balances which total$5,586,716.09, from the accounts receivable of Collier
County Fund 490 (Emergency Medical Services) finding diligent efforts to collect have
been exhausted and proved unsuccessful. (Commissioner Taylor's request)
Continue Item 16J2 Indefinitely until such time as the Clerk certifies that the payables presented in
this report have been pre-audited as previously specified by the Board: To provide to the Board a
"Payables Report" for the period ending March 16,2016 pursuant to the Board's request.
(Commissioner Fiala's request)
Time Certain Items:
Item 10B to be heard at 10:00 a.m.
3/22/2016 16.E.1.
EXECUTIVE SUMMARY
Recommendation to adopt a resolution authorizing the removal of 7,608 ambulance service
accounts and their respective uncollectible accounts receivable balances which total $5,586,716.09,
from the accounts receivable of Collier County Fund 490 (Emergency Medical Services) finding
diligent efforts to collect have been exhausted and proved unsuccessful.
OBJECTIVE: Adoption of a resolution authorizing the removal of$5,586,716.09 in ambulance service
fee receivables from the accounts receivable for Fund 490 (Emergency Medical Services). This request
represents total uncollected ambulance service fees for 7,608 accounts from Fiscal Year 2012 where
diligent efforts to collect have been exhausted and proved unsuccessful.
CONSIDERATIONS: Collier County began providing emergency ambulance transportation services in
1981. Unlike the majority of governmental services provided by the County, where fees are normally
received before services are provided,emergency ambulance services are provided and fees are received
after the fact.This"service before fee"scenario is due to the County's responsibility to protect the public
health,safety and welfare.
The chart below identifies ambulance service fee activity for Fiscal Year 2012.
Gross Charges Contractual & Amount Collection Write-Off Write- Total
Billed Other Adjustments Net Billed Collected Net% Amount Off% Accounts
r2„108,285.25 6,505,643.68 15,602,641.57 10,015,925.48 64% 5,586,716.09 36% 7,608
As can be seen in the preceding chart, there are two types of adjustments that can be made to an
ambulance service account: Contractual and/or bad debt.
Contractual adjustments represent Collier County's acceptance of the Federal Medicare limits on amounts
that can be collected for medical services,Medicaid statutory limits,Railroad Retirement statutory limits,
and Victim Compensation Rights statutory adjustments. Receivables are recorded at 100%. When
payment is received,contractual adjustments are recorded as a reduction to revenue.
The annual review of past due accounts was completed and accounts deemed uncollectible were identified
by the EMS department. Collection efforts for these accounts have been exhausted. Bad debt is
recognized for a variety of reasons, including patients who cannot be located, services provided to
transients or migrants, patients who die with no assets and bankruptcies. These accounts cannot be
removed without the Board's adoption of an authorizing resolution. Detailed reports listing the accounts
to be removed are on file in the Office of Emergency Medical Services.
The Finance Department, in accordance with generally accepted accounting procedures, annually
estimates and sets an allowance for bad debts based on accounts receivable analysis.
Those accounts for which the billing agency has exhausted their collection attempts were sent to the
County's contracted collection agency. If any payments are received,they will be processed through the
Board's accounting system.
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FISCAL IMPACT: Removal of$5,586,716.09 from the EMS Accounts Receivable will remove 7,608 /"\
individual customers' accounts and reduce the allowance for doubtful accounts in fund 490.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney.
County Resolution No.08-27,Section 2.H and I,provides as follows:
H. Throughout the fiscal year, the EMS Billing Section 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.
I. The Board may, after reviewing these past due accounts and after fmding that diligent efforts at
collection have been unsuccessful, remove these past due accounts from active accounts receivable in
accordance with generally accepted accounting procedures and pursuant to law by Resolution.
By approving this item, the Board is finding that diligent efforts at collection have been unsuccessful.
This item is sufficient as to form and legality and requires a majority vote for Board approval. JAK
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this
action.
RECOMMENDATION:Adopt a resolution authorizing the removal of 7,608 individual accounts with a
total receivable balance of $5,586,716.09 from the Emergency Medical Services Fund (Fund 490)
accounts receivable.
PREPARED BY: Artie R.Bay, Supervisor,EMS Admin.,Emergency Medical Services
Attachments: FY 12 Write Off Resolution
Billing Resolution 8-27
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.E.16.E.1.
Item Summary: Recommendation to adopt a resolution authorizing the removal of 7,608
ambulance service accounts and their respective uncollectible accounts receivable balances
which total $5,586,716.09, from the accounts receivable of Collier County Fund 490 (Emergency
Medical Services) finding diligent efforts to collect have been exhausted and proved
unsuccessful.
Meeting Date: 2/23/2016
Prepared By
Name: BayArtie
Title: Supervisor-Accounting,Administrative Services Department
1/19/2016 8:44:31 AM
Approved By
Name: pochopinpat
Title: Operations Coordinator,Administrative Services Department
Date: 1/19/2016 10:49:30 AM
Name: KopkaWalter
Title: Chief-Emergency Medical Services, EMS Operations
Date: 1/19/2016 11:58:22 AM
Name: KlatzkowJeff
Title: County Attorney,
Date: 1/19/2016 12:02:16 PM
Name: PriceLen
Title: Department Head-Administrative Svc,Administrative Services Department
Date: 2/9/2016 4:40:07 PM
Name: WellsLaura
Title: Management/Budget Analyst, Senior, Office of Management&Budget
Date: 2/10/2016 11:00:36 AM
Name: KlatzkowJeff
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Title: County Attorney,
Date: 2/10/2016 1:49:34 PM
Name: CasalanguidaNick
Title: Deputy County Manager,County Managers Office
Date: 2/14/2016 12:36:08 PM
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RESOLUTION NO.2016-
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, TO AUTHORIZE THE REMOVAL FROM
THE BOOKS AND RECORDS OF COLLIER COUNTY CERTAIN ACCOUNTS
AND THEIR RESPECTIVE BALANCES WHICH HAVE BEEN IDENTIFIED
AS UNCOLLECTIBLE.
WHEREAS, Collier County provides emergency ambulance transportation services
throughout Collier County; and
WHEREAS, emergency ambulance transportation service fees are received by the County
after the services have been rendered due to the County's responsibility to protect the public health,
safety and welfare;and
WHEREAS, the County is unable to collect some debts, and others the Board is statutorily
prohibited from collecting or due to contractual arrangements cannot be collected; and
WHEREAS,the County's generally accepted and practiced accounting method to recognize an
allowance for bad debts is a periodic or annual bad debt expense in the books and records for accounts
that have been identified by the Department as un-collectible;and
WHEREAS, Rule 69I-71, Florida Administrative Code, allows the Board to adjust accounts
receivable for less than the full amount if the accounts have not been reported to the Department of
Financial Services,Division of Accounting and Auditing for disposition;and
WHEREAS, the subject accounts have not been reported to the Department of Financial
Services,Division of Accounting and Auditing;and
WHEREAS, County Resolution No. 08-27, Section 2. H and I, provides for removing these
accounts from the Board's Emergency Medical Services Fund Accounts Receivable;and
WHEREAS, the Board of County Commissioners hereby finds that diligent efforts at
collection have proven unsuccessful and circumstances warrant the adjustment.
NOW THEREFORE, IT IS RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that:
1. The following chart sets forth the charges billed, the portion uncollectible due to
statutory prohibitions and Board contractual arrangements, the amount collected and the balance of
accounts receivable to be written off(FY 12):
1
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Gross Charges Contractual & Amount Collection Write-Off Write- Total
Billed Other Adjustments Net Billed Collected Net% Amount Off% Accounts
22,108,285.25 6,505,643.68 15,602,641.57 10,015,925.48 64% 5,586,716.09 36% 7,608
2. The Board authorizes staff to remove 7,608 individual accounts and their respective balances
for a total of$5,586,716.09 from the Board's Emergency Medical Services Fund. Same amount will
be removed from the Accounts Receivable General Ledger control account, and the Allowance for
Doubtful Accounts General Ledger control account in the Board's Emergency Medical Services Fund.
This Resolution adopted on this day of February 2016 after motion, second and majority
vote favoring adoption.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK,CLERK OF COLLIER COUNTY,FLORIDA
By:
,DEPUTY CLERK DONNA FIALA, CHAIRMAN
Ap i. o orm and legality:
rl
Jeffre T ri : .tzkow
Coun orney
2
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RESOLUTION NO.08- 27
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,PROVIDING FOR UP-DATED EMS USER
FEES FOR COLLIER COUNTY AMBULANCE SERVICES, UP-DATED
BILLING AND COLLECTION PROCEDURE, HOSPITAL TRANSPORT
BILLING AND FEES, ADJUSTMENTS OF EMS USER FEES PURSUANT
TO COLLIER COUNTY ORDINANCE NO.96-36,WAIVER OF EMS USER
FEES FOR SPECIAL EVENTS, AND AN UPDATED PROCEDURE FOR
APPROVING HARDSHIP CASES AND PAYMENT PLANS;SUPERSEDING
RESOLUTION NO.07-192;AND PROVIDING FOR AN EFFECTIVE DATE.
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,the Board of County Commissioners recently entered into an Agreement with
Advanced Data Processing, Inc. (hereinafter referred to as to "Billing Consultant") to provide
collection services for ambulance services and associated fees;and
WHEREAS,this Resolution is intended to apply irrespective of whether EMS billing staff,
Advanced Data Processing,Inc.,or any other billing consultant is responsible for the collection of
fees for ambulance services;and
WHEREAS, Collier County Ordinance No. 96-36 § 5 provides that the user fees for
ambulance services may be established by Resolution of the Board of County Commissioners
(hereinafter referred to as to"the Board").
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that:
SECTION ONE: EMS USER FEES
BASE RATES:
SERVICE LEVELS CODES
BASE CHARGES
A. EMS—BLS NON-EMERGENCY A0428 $ 700.00
B. EMS—BLS EMERGENCY A0429 $ 700.00
C. EMS—ALS 1 NON-EMERGENCY A0426 $ 700.00
D. EMS—ALS 1 EMERGENCY A0427 $ 700.00
E. EMS—ALS 2 EMERGENCY A0433 $ 750.00
F. EMS—SPECIALTY CARE A0434 $ 800.00
G. EMS—TREATMENT W/O TRANSPORT A0098 $ 175.00
H. EMS--HELICOPTER A0431 $ 5,900.00
MILEAGE RATES:
SERVICE LEVELS CODES MILEAGE CHARGE
A. EMS—GROUND UNIT A0425 $ 12.25
(Minimum Charge of I mile and no cap)
B. EMS—AIR UNIT A0436 $ 110.00
SPECIAL EVENTS AND MISCELLANEOUS RATES:
SERVICE LEVELS RATES
A TWO(2)MEDICS/ONE ALS VEHICLE(PER HOUR) $ 150.00
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B, ONE(1)MEDIC/NO VEHICLE(PER HOUR) $ 50.00
COPIES*:
Subject to statutory exemptions, "public records" are required by Chapter 119,F.S. to be
open to inspection and copying. Consistent with Chapter 119, Resolution No.07-327 establishes
copying fees as follows:
COPIES OF DOCUMENTS RATES
A. One-sided copy which is 14 inches by 8 '/3 inches or less $ .15
B. Two-sided copy which is 14 inches by 8'/: inches or less $ .20
COPY SERVICES
The actual cost of duplication for all other copies will be charged. The first hour of cost of
duplication will not be charged. "Actual cost of duplication"is defined in§ 119.07(1),FS as"the
cost of the material and supplies used to duplicate the record," but does not include the labor cost
and overhead cost associated with such duplication.
*Copying fees are subject to change only to the extent that either Chapter 119, F.S. or
Resolution No.07-327,or both,are amended,replaced,or superseded.
PAST DUE ACCOUNTS
INTEREST ON PAST DUE ACCOUNTS $ 1%monthly
SECTION TWO: BILLING 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 provision of service,as service dynamics reasonably allow. Unpaid fees and
charges,subsequent to time of service shall be reflected in an accounts receivable subsidiary
ledger system to be maintained by the EMS Department.
B. EMS Billing Staff will transmit all data necessary to Billing Consultant to process the claim.
I. Billing Consultant will send an initial bill to the service recipient's or responsible
party's insurance carrier as soon as insurance information has been received,
validated,and entered by the Milling Consultant on the account.
2. When a valid patient address is present,the Billing Consultant will follow the patient
statement cycle outlined below.
i. An initial statement for ambulance services, including the HIPAA notice of
privacy practices shall be sent fourteen (14) or more days after the data is
entered by the Billing Consultant, but no later than 30 days after service has
been provided.
ii. If a non-Medicaid account remains unpaid, statements will be sent to the
patient no later than every 60 days from the last filed date. If a claim is denied,
a bill will be sent to the service recipient or responsible party.
iii. For Medicaid accounts, if the claim is denied because of no coverage at the
time of service,or because it was determined to be not medically necessary to
be transported by ambulance, a bill will be sent to the service recipient or
responsibly party.
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iv. In the event the service recipient or responsible party does not have or does not
provide proof of insurance coverage, statements will be sent to the patient no
later than every 60 days from the last statement date.
C. The Billing Consultant will provide a file with patients to be sent to collections to the
County's contracted collection agency when all attempts to collect on the account have been
exhausted by the Billing Consultant. The County may direct the Billing Consultant to not
send a patient to collections at any time. Billing Consultant may send a patient to
collections prior to exhaustion of all collection efforts when:
1. The patient account has an invalid address.
2. Billing Consultant is directed by County to send a patient to collections.
D. Interest will be assessed at 1% per month on all accounts that are sent to the County's
contracted collection agency.
E. 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 the time fail to
meet the terms and conditions of the payment plan for a period of(60)sixty days,the unpaid
balance shall reenter the collections process set forth in Section C.above at the point in the
collections process at which it was taken out for a payment plan to be administered.
F. When ambulance service bill(s),at the any stage in this billing and collection procedure,are
returned because the Postal Service cannot effectuate delivery, the EMS Billing Section
shall make 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.
G. Nothing contained in this Section shall preclude reasonable telephone or other appropriate
contact for billing and collection purposes,in accordance with all applicable laws.
H. Throughout the fiscal year,the EMS Billing Section 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.
I. The Board may, 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.
J. Probate Estate Cases: Should a decedent have an unpaid balance for ambulance services,
the following shall occur:
1. The decedent's Personal Representative will notify EMS Billing Staff that a
probate estate has been filed with the Probate Court.
2. EMS Billing Staff shall ensure that a Notice of a Claim is timely filed with the
Probate Court.
3. EMS Billing Staff shall ensure that the Office of the County Attorney is timely
notified of such claim and provided with: 1)a copy of ambulance bill(s),2) all
correspondence between EMS Billing Staff/Billing Consultant) and Personal
Representative, 3)Notice of Claim filed with the Probate Estate, and any other
information necessary to pursue the claim.
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4. The Office of the County Attorney shall take all reasonable actions that are
necessary to pursue such claim, including but not limited, to filing a lawsuit in
the County Court to pursue such claim,
5. If the estate has assets and$10,000 or less is owed for ambulance services,the
EMS Director and the County Attorney (or his designee)are authorized to take
reasonable actions to reach a settlement with the Personal Representative or his
attorney. Should a settlement be reached, the EMS Director and the County
Attorney(or his designee)are authorized to execute a satisfaction and/or release
on behalf of the County. If the estate has assets and in excess of$10,000 is owed
for ambulance services,any negotiated settlement/compromise of the ambulance
billing claim shall be approved by the Board of County Commissioners. If the
estate has nominal assets or no assets,the County Manager may waive the rates,
fees, and charges as set forth in Ordinance No. 96-36, as it may be amended,
replaced,or superseded.
K. All accounts with a balance of$10 or less will be written off.
SECTION THREE: HOSPITAL TRANSPORT BILLING AND FEES
A. The fees set forth in Section One of this Resolution shall apply to ambulance transports that
occur between a hospital's facilities.
B. Should a hospital within the boundaries of Collier County have the need for a transport of a
patient between hospital facilities located within the boundaries of Collier County,
ambulance transport will be provided. "^
C. Should a hospital within the boundaries of Collier County have the need for a transport of a
patient to hospital facilities located outside the boundaries of Collier County, the County,
will subject to equipment and manpower availability, at its sole discretion, utilize its
resources to provide patient transport.
D. Hospitals requesting ambulance transports shall be invoiced directly for ambulance transport
service on a monthly basis.
SECTION FOUR: ADJUSTMENT OF EMS USER FEES
The following shall be minimum guidelines for adjustments to ambulance service fees. The
Board of County Commissioners,in accordance with criteria established by the enabling Ordinance,
may authorize other adjustments.
A. Medicare and Medicaid Adjustments. Contractual adjustments under Medicare and/or
Medicaid assignment will be made in accordance with applicable Medicare and/or
Medicaid rules and regulations.
B. Victim's Compensation Contractual Adjustments. Contractual adjustments will be
made in accordance with applicable state,federal and local rules and regulations.
C. Worker's Compensation Contractual Adjustments. Contractual adjustments will be
made in accordance with applicable state,federal and local rules and regulations.
D. County Employee Adjustments. Board of County Commissioners and Constitutional
Officers'employees that have Primary coverage under Collier County's insurance policy
will be responsible for any deductibles,co-payments or unpaid balances. An employee
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may dispute his/her ambulance charge in accordance with procedures set forth in
Ordinance No.96-36.
E. Chatnnus/Tricare Adjustments. Contractual adjustments will be made in accordance
with applicable Champus/Tricare rules and regulations.
F. Railroad Retirement Adjustments. Contractual adjustments will be made in accordance
with applicable state, federal and local rules and regulations pertaining to Railroad
Retirement Adjustments.
G. Social Services Adjustments. Contractual adjustments will be made in accordance with
rules established by the County Manager and memorialized by a memorandum of
understanding executed by the Social Services Director and the EMS Director.
SECTION FIVE: WAIVER OF EMS USER FEE FOR SPECIAL EVENTS.
Pursuant to Ordinance No, 96-36, and from the effective date of this Resolution, user fees
for EMS ambulance stand-by services may be waived if the Board finds that a valid public purpose
has been established in recognition of their charitable contributions to the Community.
SECTION SIX: 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 Federal Poverty guidelines,as
used by the Social Services Department of 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 agreed 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.
SECTION SEVEN: SUPERCISION OF RESOLUTION 07-192
This Resolution shall supersede Resolution No.07-192
SECTIQN EIGHT: EFFECTIVE DATE
This Resolution shall become effective on January 29,2008
PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier
County,Florida,this X71+' day of TIL'at iitit ,2008.
ATTEST:` BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK;`CLERK COLLIER COUNTY,FLORIDA
By:Tffai TO ittlNNIN ,CHA • : -%)(714:a1.-4,roar...----'
ffbvtti to forhi
legal sufficiency: erg
Jennifer A.Belp dib
Assistant County Attorney
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