The Board of Supervisors ("the Board") hereby designates the County's Department of Fire, Rescue, and Emergency Management ("DFREM") as the primary agent for the purpose of emergency medical service transport reimbursement program management.
(Ord. 14-02. Passed 1-15-14.)
(a) “Basic Life Support, (BLS):” Medical treatment, assessment or procedures provided to a patient by EMS personnel who are certified as either an Emergency Medical Technician-Basic or Emergency Medical Technician in accordance with Virginia Emergency Medical Services Regulations 12 VAC-31-10.
(b) “Advanced Life Support, Level 1 (ALS-1):” Medical treatment, assessment or procedures provided to a patient beyond the scope of Basic Life Support by EMS personnel who are certified as an Emergency Medical Technician (EMT) - Enhanced, Intermediate or Paramedic in accordance with Virginia Emergency Medical Services Regulations 12 VAC-31-10.
(c) “Advanced Life Support, Level 2 (ALS-2):” Advanced life support medical treatment provided to a patient by personnel who are certified as an Emergency Medical Technician (EMT) - Intermediate or Paramedic, that includes the administration of at least three medications by intravenous push/bolus or by continuous infusion excluding crystalloid, hypotonic, isotonic, and hypertonic solutions (Dextrose, Normal Saline, Ringer's Lactate); or providing transportation, medically necessary supplies and/or providing one or more of the following the medically necessary ALS procedures: Manual defibrillation/cardioversion; Endotracheal intubation; Central venous line; Cardiac pacing; Chest decompression; Surgical airway; or Intraosseous line.
(d) “Emergency Medical Services ("EMS"):” Services utilized by the County's Combined Fire-Rescue System ("the system") in responding to those persons in need of immediate medical care within the County and in any neighboring jurisdiction having entered into a Mutual Aid agreement with the County.
(e) “Mileage:” The distance traveled by an ambulance from the point where the patient is picked up, to the hospital and/or a rendezvous point.
(f) “Patient:” Person transported by a system EMS-licensed ambulance.
(g) “Reasonable Billing Efforts:” The issuance of a bill to the patient or to the party responsible for the patient's personal financial obligations, additional billings as necessary, and telephone calls or personal contacts which constitute a genuine, rather than token, billing effort.
(h) “Third Party Payer:” insurance carrier or other responsible provider of coverage having the responsibility of paying for emergency medical services rendered to a patient as a result of that patient's accident, injury or illness.
(Ord. 14-02. Passed 1-15-14.)
(a) No person requiring EMS shall be denied services due to a lack of insurance or ability to pay.
(b) Any applicable charges for EMS transport rendered shall be billed directly to the patient and/or to the patient's third party payer.
(c) All patients and/or their financially responsible parties, insurers or carriers, will be billed for EMS transport provided by the system according to the Fee Schedule established herein, and shall be responsible for any co-payment or deductible amounts not satisfied by public or private insurance. The third party billing agency shall make reasonable collection efforts for all such balances according to the most current rules or regulations set forth in applicable sections of the Medicare Carriers Manual and may seek reimbursement from any applicable coinsurance carriers for such amounts.
(d) Any patient not billed on assignment by the County's billing agent and who receives payment directly from a third party payer for ambulance transport rendered by the system is obligated to remit such monies to the County in the event the system has not been paid for services rendered.
(e) All County employees and members of Volunteer Fire and Rescue Companies authorized by the Board of Supervisors will not be billed for EMS transports or services rendered that result from a line-of-duty injury or illness.
(Ord. 14-02. Passed 1-15-14.)
(a) A detailed listing of patients who are transported and/or have utilized emergency medical services will be compiled by the third party billing agent, system EMS providers and/or the designated Program Manager. This information will be transmitted to any third party billing agency selected by DFREM to be responsible for reimbursement efforts. The information will, however, be subject to the confidentiality requirements of applicable law.
(b) The fees established by the Board of Supervisors for system EMS transports may be adjusted annually in accordance with the federally approved Medicare Fee Schedule or the Consumer Price Index (CPI) as recommended by the County Administrator in the annual budget proposal to the Board. Any change to the fee schedule shall be approved by the Board and included in the adopted appropriation resolution.
(c) The County Treasurer's Office will certify and provide the applicable CPI of the EMS Transport Reimbursement Program to the designated Program Manager and third party billing agency. The third party billing agency is to notify the Program Manager and County Treasurer's Office in writing of all applicable Medicare authorized increases; if no increases are applicable to the County, then the Treasurer will validate any increases to the fee schedule for the following County fiscal year.
(Ord. 14-02. Passed 1-15-14.)
(a) No local tax revenues are to be used to fund any EMS transport reimbursement efforts. As such, the administrative costs, contractual requirements and other necessary costs associated with conducting the program will derive directly from the EMS transport reimbursement revenue and will be paid first prior to any distribution.
(b) Revenues will be distributed with appropriate documentation for all companies to review, audit, and dispute, if necessary. The Treasurer will adjudicate all disputes as necessary. All disputes must be initiated and provided to the designated Manager of EMS Transport Reimbursement Program within thirty days of receipt of the quarterly distributions by the Volunteer Fire and/or Rescue Company which believes there is an issue with the payment received.
(c) The revenue distribution will be based on the following formula for calculation of the shares for each of the Volunteer Fire and Rescue Companies and DFREM:
(1) The totals of all payments received will be divided by the total number of calls (minus all programmatic costs required to generate the revenue; i.e. third party billing agency fees, administrative costs) and will result in a net revenue-per-run.
(2) The net revenue-per-run will then be applied in the following manner:
A. 20% of the total net revenue will be disbursed to the Company or DFREM which owns the apparatus used for the transport.
B. 20% of the total net revenue will be disbursed to the Company or DFREM that owns the Station for the call.
C. 25% of the total net revenue will be disbursed to a Company or DFREM that provided Staff for the transport; either BLS or ALS, and if circumstances where two Companies responded, the Company staff that provided the highest level of treatment during the transport will receive the payment.
D. 25% of the total net revenue will be retained by the County for the provision of Fire Rescue system infrastructure.
E. 10% of the total net revenue will be provided to the "first-responder" unit assigned to a call which supports EMS transporting units. If no units are assigned for first response, then the 10% is contributed to a pool. At the end of the Fiscal Year, this pool will be distributed by the County Treasurer in equal shares to the Fire Companies that do not provide EMS transports.
(Ord. 14-02. Passed 1-15-14.)