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143.15 EMERGENCY MEDICAL SERVICE BILLING.
(a) Definitions. As used in this section and for reimbursement purposes, the following words and phrases shall have the meanings respectfully ascribed to them as follows:
(1) “Advanced Life Support” means any pre-hospital intervention by personnel certified at the level of EMT Para-Medic as described in Ohio R.C. Chapter 4765. Such interventions include but are not limited to cardiac monitoring and interpretation of cardiac rhythms, external cardiac pacing, cardio version, end tracheal intubations, intravenous cannulation, intraosseous infusion, emergency needle thoracotomy and administration of medications.
(2) “Basic Life Support” means any pre-hospital non-invasive intervention by personnel certified at the level of EMT-Basic as described by Ohio R.C. Chapter 4765. Such interventions include, but are not limited to non- invasive methods of airway control, oxygen administration, bleeding control, splinting of fractures, treatment of shock, patient assessment and recording vital signs.
(3) “Transport” means to carry or convey a person by a publicly owned and/or operated motor vehicle being used in response to a call for emergency medical assistance from one location to another.
(4) “Fees for Service” means the fee associated with the emergency transportation of each individual requiring either basic life support or advanced life support shall be the usual, customary and reasonable (UCR) charge established by insurance companies within the region.
(b) Payment of Fee.
(1) No person shall be charged for basic life support or advanced life support treatment unless he/she is transported by the City’s Emergency Squad.
(2) Every person being transported by the Emergency Squad or some other person on behalf of that person being transported shall complete and execute an assignment of benefits form at the time of such Emergency Squad transport.
(3) If either the person being transported or some other person on behalf of that person being transported, when, for any reason, the person being transported is unable to execute an assignment of benefits, fully, truthfully and accurately completes and executes an assignment of benefits form which entitles the City to recover its Emergency Life Squad transportation fee directly from the appropriate public or private insurer or any federal, state or county public welfare agency which may be responsible for paying the costs of the treated person’s emergency transportation, the person being transported shall not be held liable for all or any part of the fee set forth above.
If the person being transported or some other person on behalf of that person being transported provides incomplete, false or misleading information which prevents the City from recovering upon its assignment of benefits, the person being transported shall not be relieved of liability for the fee set forth above until a complete, truthful and accurate assignment of benefits form has been prepared, signed and presented to the Finance Department.
If in spite of the completion of an assignment of benefits form, the person being transported receives all or any part of the City’s Emergency Life Squad transportation fee, the person being transported shall not be relieved of liability for such fee until he or she has remitted to the City all moneys he or she received for payment of such fee for such Emergency Life Squad service.
(4) If the person being transported has no insurance and no other payment source for the Emergency Life Squad fee exists, or if the appropriate public or private insurer or federal, state or county welfare agency pays less than the full Emergency Life Squad fee, the balance still due and owing for transportation of that person shall be waived by the City as payment in full unless this provision violates any state or federal law as it pertains to the collection of fees.
(c) Establishment of Rates. It is hereby authorized and approved that the third party administrator selected by the City shall establish the fee submitted to the insurance carrier, determinate upon the level of the service provided to the individual(s) being transported.
(d) Revenue Disbursement.
(1) All revenues generated by the charges for emergency medical services shall be disbursed in the following manner: Sixty percent (60%) to the Fire Department New Equipment Fund (301) until the cash fund balance reaches nine hundred thousand and no/100 dollars ($900,000.00); Twenty percent (20%) to the Medical Supply Fund (302) until the cash fund balance reaches one hundred fifty thousand and no/100 dollars ($150,000.00); the remaining revenues received shall be placed in the General Fund (101) of the City.
(2) Administration fees to operate the program shall be paid to the administrator at the rate so established by contract.
(Ord. 005-2022. Passed 3-1-22.)