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Agenda 02/10/2015 Item #16E2 2/10/2015 16.E.2. EXECUTIVE SUMMARY Recommendation to adopt a resolution authorizing the removal of 7,102 ambulance service accounts and their respective uncollectible accounts receivable balances which total S5,510,345.36, 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$5,510345.36 in ambulance service fee receivables from the accounts receivable for Fund 490 (Emergency Medical Services). This request represents total uncollected ambulance service fees for 7,102 accounts from Fiscal Year 2011 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 2011. Contractual& Gross Charges Other Amount Collection Write-Off Write- Total Billed Adjustments Net Billed Collected Net% Amount Off% Accounts FY11 20,531,496.75 5,842,322.14 14,689,174.61 9,178,829.25 62% 5,510,345.36 38% 7,102 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 iviedicare 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. Packet Page-513- 2/10/2015 16.E.2. 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. FISCAL IMPACT: Removal of $5,510,345.36 from the EMS Accounts Receivable will remove 7,102 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 finding 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 7,102 individual accounts with a total receivable balance of$5,510,345.36 from the Emergency Medical Services Fund (Fund 490)accounts receivable. PREPARED BY: Artie R. Bay, Supervisor, EMS Admin., Emergency Medical Services Attachments: FY 11 Write Off Resolution, Billing Resolution 8-27 Packet Page -514- 2/10/2015 16.E.2. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.2. Item Summary: Recommendation to adopt a resolution authorizing the removal of 7,102 ambulance service accounts and their respective uncollectible accounts receivable balances which total $5,510,345.36, 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: 2/10/2015 Prepared By Name: BayArtie Title: Supervisor-Accounting, EMS Operations 12/22/2014 8:06:11 AM Approved By Name: KopkaWalter Title: Chief-Emergency Medical Services, EMS Operations Date: 12/22/2014 8:33:47 AM Name: pochopinpat Title: Administrative Assistant, Administrative Services Division Date: 12/22/2014 12:06:57 PM Name: SummersDan Title: Director-Bureau of Emergency Services, Bureau of Emergency Services Date: 12/22/2014 1:55:28 PM Name: KlatzkowJeff Title: County Attorney, Date: 12/22/2014 3:33:31 PM Name: PriceLen Title: Administrator-Administrative Services, Administrative Services Division Date: 1/15/2015 11:26:46 AM Name: KlatzkowJeff Packet Page-515- 2/10/2015 16.E.2. Title: County Attorney, Date: 1/15/2015 3:29:22 PM Name: KimbleSherry Title: Management/Budget Analyst, Senior, Office of Management&Budget Date: 1/16/2015 2:54:30 PM Name: OchsLeo Title: County Manager, County Managers Office Date: 2/2/2015 10:48:35 AM Packet Page -516- 2/10/2015 16.E.2. RESOLUTION NO.2015- 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 1, 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: Packet Page -517- 2/10/2015 16.E.2. Contractual& Gross Charges Other Amount Collection Write-Off Write- Total Billed Adjustments Net Billed Collected Net% Amount Off% Accounts FY11 20,531,496.75 5,842,322.14 14,689,174.61 9,178,829.25 62% 5,510,345.36 38% 7,102 2. The Board authorizes staff to remove 7,102 individual accounts and their respective balances for a total of$5,510,345.36 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 2015 after motion, second and majority vote favoring adoption. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, CLERK OF COLLIER COUNTY, FLORIDA By: , Deputy Clerk Tim Nance, Chairman App 14 - I . •rm and legality: Jeffr: • 1 a ow Coun , ' orney 2 Packet Page-518- 2/10/2015 16.E.2. 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 1 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 Packet Page -519- 2/10/2015 16.E.2. B, ONE(I)MEDIC/NO VEHICLE(PER HOUR) S 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'/2 inches or less S .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),F.S. 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 S 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. 1. 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 Billing 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. Packet Page -520- 2/10/2015 16.E.2. 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. 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. Packet Page -521- 2/10/2015 16.E.2. 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 510,000 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 of 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 Packet Page -522- • 2/10/2015 16.E.2. may dispute his/her ambulance charge in accordance with procedures set forth in Ordinance No.96-36. E. Chamnus/Tricare Adjustments. Contractual adjustments will be made in accordance with applicable ChampuslIricare 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 510.00 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 SECTION EIGHT: EFFECTIVE DA T E This Resolution shall become effective on January 29,2008 PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier County,Florida,this 01-7111 day of —SO k ti tt. ,2008. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E.BROCK,•'.CLERK COLLIER COUNTY,FLORIDA la „" •.;st TOM • NNIN ',C l i p2 is rbvt lit to fotiri . legal sufficiency: CLB ib Jenni A.Belpedi Assistant County Attorney Packet Page -523-