The Borough of Fort Lee recognizes the need to bill patients for the provision of emergency medical services and transportation to aid in the provision of those services.
No person requiring emergency medical services and/or transportation shall be denied services due to a lack of insurance or ability to pay levied charges.
Whereas the FLA is funded by local taxation, it is in the best interest of the residents of Fort Lee to establish a policy for EMS billing in accordance with the Health Care Finance Administration (HCFA) guidelines (as same may be from time to time amended or supplemented) so that individuals who are legally domiciled in the Borough of Fort Lee will not be responsible for the payment of any uninsured out-of-pocket expenses.
The FLA shall obtain the necessary licensure from the New Jersey State Department of Health to provide emergency medical services and transportation (the "program"). The FLA is a Department of the Borough of Fort Lee.
The Borough of Fort Lee shall apply for a provider number from the Federal and State Medicare/Medicaid Programs, enabling the municipality to institute a third-party payment plan (the "payment plan") for provided services.
All patients, whether or not a legal domiciliary of the Borough of Fort Lee, and/or their financially responsible parties, insurers or carriers, will be billed for emergency medical services and transportation provided by the FLA, according to a fee schedule established by the Mayor and Council of the Borough of Fort Lee.
A patient who receives emergency medical services or transportation from the FLA is obligated, at the time of service or as soon as practicable thereafter, to provide the FLA with all pertinent identification, insurance and/or payment information to facilitate the Borough's billing of third-party payment sources for services rendered. The Borough may, at its option, and shall, where required by law, bill insurers or carriers on a patient's behalf and accept payment on an assignment basis.
All patients who are not legally domiciled in the Borough of Fort Lee shall be liable for any copayment or deductible amounts not satisfied by public or private insurance, and the Borough shall make reasonable collection efforts for all such balances according to the most current rules or regulations set forth by applicable Health Care Financing Administration federal policies and regulations. The Borough may bill any applicable co-insurance carriers for such amounts. Exceptions include only those instances where the Borough has knowledge of a particular patient's indigence or where the Borough has made a determination that the cost of billing and collecting such copayments or deductibles exceeds or is disproportionate to the amounts to be collected.
The Borough shall not bill any individual legally domiciled in the Borough of Fort Lee for any fee, balance, deductible, or copayments not satisfied by public or private insurance, including Medicare/Medicaid, nor will the Borough bill an individual legally domiciled in the Borough of Fort Lee for emergency medical services, provided that individual is not covered by private or public insurance.
The Borough of Fort Lee may, either directly or through any third-party billing agency with which it has contracted for billing and/or collections for emergency medical services, make arrangements with patients and/or their financially responsible party for installment payments of bills or forgive any bill or portion thereof, so long as the Borough determines that:
Institution of collection lawsuit(s).
[Added 9-8-2016 by Ord. No. 2016-31]
The Borough of Fort Lee hereby authorizes the Borough Administrator to utilize the services of the Borough Attorney, or separately designated attorney(s) or the Borough's chosen third party billing agency, as a final resort, to institute a lawsuit(s) to collect delinquent payments for unpaid ambulance service fees.
Said lawsuits may seek such delinquent fees from insurance providers, from nonresident service utilizers and from resident service utilizers, who were reimbursed by their insurers for said ambulance services, but who have not tendered that reimbursement to the Borough.
This authorization to file lawsuits includes the right, where appropriate, to name as defendants, authorized guardians of the delinquent service utilizers or their intestate or testate estates. Further, said lawsuits may seek interest, penalties, costs of administration and suit, including costs of investigation, service, legal fees and court costs, in addition to the principal sum which is due and owing.
Finally, the Borough Administrator is authorized directly, or through counsel and/or the third party billing agency, to negotiate, compromise and settle any such lawsuits threatened or filed.
A patient who has received emergency medical or transport services from the FLA, including an individual legally domiciled in the Borough of Fort Lee, for whom the Borough of Fort Lee has not received payment from a third-party payer on assignment, and who receives payment directly from a third-party payer for emergency medical services rendered by the FLA, is obligated to remit such monies to the Borough in the event the Borough has not been paid for services rendered. Patients who do not remit such monies may be held liable for costs of collection in addition to the charges for emergency medical services rendered.
[Amended 9-8-2016 by Ord. No. 2016-31]
The Borough of Fort Lee shall be authorized to enter into contracts with area hospitals that provide advanced life support (ALS) services to patients that are transported by the FLA. This will allow the hospitals to bill for all emergency medical services and, if so agreed, timely reimburse the Borough for its transportation costs within 45 days of receiving payment.
[Amended 9-8-2016 by Ord. No. 2016-31]
The Borough of Fort Lee is hereby authorized to enter into a contract with a third-party billing agency for performance of EMS billing and collection services; provided, however, that the following standards for such third-party billing contracts are met:
The third-party billing agency has in place a compliance program conforming to standards set forth in the office of Inspector General's Compliance Program Guidance for Third-Party Medical Billing Companies, 63 Federal Register 70138, as amended.
Neither the billing agency nor any of its employees are subject to exclusion from any state or federal health-care program.
The billing agency is bonded and/or insured in amounts satisfactory to the Borough of Fort Lee.
A detailed listing of patients who utilize emergency medical services and or transport provided by the FLA will be compiled by the Borough of Fort Lee. This information will be transmitted to the third-party billing agency. The information will be subject to the confidentiality requirements of applicable law. This information will include, at a minimum, the following:
Name, address, and telephone number of patient.
Name, address, and claim number of insurance carrier, if applicable.
Date, time, and EMS chart number.
Point of origin and destination.
Odometer reading at point of pickup and destination.
Reason for transport/patient's complaint/current condition.
Itemization and description of services provided and charges.
Signature of the patient or authorized decision maker.
Name of receiving physician.
Names, titles, and signatures of ambulance personnel, when possible.
The third-party billing agency shall obtain the information from the FLA and will bill the patient and/or his/her financially responsible parties, insurers or carriers, according to the fee schedule established herein; provided, however, that the third-party billing agency shall not bill any individual legally domiciled in the Borough of Fort Lee for any fee, balance, deductible, or copayments not satisfied by public or private insurance, including Medicare/Medicaid, nor will the Borough bill an individual legally domiciled in the Borough of Fort Lee for emergency medical services or transport, provided that that individual is not covered by private or public insurance.
The fee for emergency medical services, transport miles per trip and nontransports where aid is provided shall be established by the Mayor and Council.
The Mayor and Council shall review the fees for services listed in Subsection D above annually and adjust said fees based on the recommendations of the Borough Administrator and the Chief Financial Officer and in accordance with the federally approved Medicare fee schedule.
The Borough of Fort Lee may, in its discretion, bill additionally for material, vehicle, and personnel costs in the case of major or unique incidents.
The Borough Administrator may promulgate rules and regulations pursuant to and not inconsistent with this chapter, state and federal law, and such rules and regulations, which rules and regulations shall become effective upon approval by resolution of the governing body of the Borough of Fort Lee.