2007-11-12 Regular Meeting, Public Hearing and Workshop Meeting

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(1) Name, address, and telephone number of patient. (2) Name, address and claim number of insurance carrier, if applicable. (3) Date, time and EMS chart number. (4) Point of origin and destination. (5) Odometer reading at point of pick up and destination. (6) Reason for transport! patient's complaint! current condition. (7) Itemization and description of services provided and charges. (8) Signature ofthe patient, when possible, or authorized decision maker. (9) Name of receiving physician. (10) Names, titles, and signatures of EMS personnel, when possible. ( e) All fees for services rendered are payable to the City of La Porte Emergency Medical Service. The fee schedule for emergency medical services shall be as established and printed in Appendix A--Fees, Chapter 30, Emergency Services, Article III, Emergency Medical Services. (f) The fees established above may be increased periodically, with EMS Chief Officer recommendation and subsequent approval by City Council. (g) The City may, in its discretion, bill additionally for material, vehicle and personnel costs in the case of major or unique incidents. (h) EMS may promulgate rules and regulations pursuant to and not inconsistent with this ordinance, state and federal law, such rules and regulations to be approved by City Council. (i) Due to the complex nature of the Health Care Industry and associated billing for related services, the City of La Porte EMS may utilize a claims processing procedure based upon the patient's payer type. Each payer type requires a unique claims process and time frame. When a patient contracts with a combination of payer types, the claims process must be extended to accommodate a claim submission to each payer and a prescribed amount of time for repayment. (j) The following policy establishes guidelines that will address the billing process, collection and bad debt for the City of La Porte EMS: (1) Major Payer Types: Patient (uninsured) Medicare Medicaid Private Health Insurance (commercial) Workman's Compensation (work related injuries) Third Party Liability (auto) (k) It is important to note that the patient may present several combinations of payer types. Although specific rules apply to identify the primary payer when multiple insurance carriers are presented, failure to identify the correct primary payer will extend the billing process; additionally, the number of insurance carriers presented will have a direct bearing on the billing time frame.