A.
The
Borough of Paramus recognizes the need to bill for the provision of
emergency medical services to aid in the provision of those services.
B.
No
person requiring EMS shall be denied services due to a lack of insurance
or ability to pay.
C.
Whereas,
the Paramus Division of Emergency Medical Services is funded by local
taxes, it is in the best interest of the residents of Paramus to establish
the payment plan in accordance with the Health Care Finance Administration
(HCFA) guidelines so that residents will not be responsible for any
out-of-pocket expenses.
A.
The
Paramus Division of Emergency Medical Services (the "Program") shall
obtain licensure from the New Jersey State Division of Health. The
Paramus Division of Emergency Medical Services is a division of the
Borough of Paramus.
B.
The
Borough of Paramus 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").
C.
All
patients, whether or not residents of the Borough of Paramus, and/or
their financially responsible parties, insurers or carriers, will
be billed for emergency medical services provided by the Paramus Division
of Emergency Medical Services according to the Fee Schedule established
herein[1] or at rates established by the Borough of Paramus from
time to time.
D.
A
patient who receives emergency medical services from the Paramus Division
of Emergency Medical Services is obligated, at the time of service
or as soon as practicable thereafter, to provide the Division of Emergency
Medical Services with all pertinent insurance and 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 may accept payment on an assignment basis.
E.
All
patients, who are not residents of the Borough of Paramus, 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
coinsurance 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.
F.
The
Borough shall not bill any Paramus resident for any fee, balance,
deductible, or copayments not satisfied by public or private insurance
including Medicare/Medicaid, nor will the Borough bill a Paramus resident
for emergency medical services provided if the resident is not covered
by private or public insurance.
G.
The
Borough of Paramus 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:
H.
A
patient, including a Borough resident, for whom the Borough of Paramus
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 Paramus Division of Emergency Medical
Services 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.
I.
The
Borough of Paramus shall be authorized to enter into contracts with
area hospitals that provide advanced life support (ALS) services to
patients that are transported by the Paramus Division of Emergency
Medical Services. This will allow the hospitals to bill for all emergency
medical services and reimburse the Borough for its transportation
costs within 45 days of receiving payment.
A.
The
Borough of Paramus 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:
(1)
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.
(2)
Neither the billing agency nor any of its employees are subject to
exclusion from any state or federal health care program.
(3)
The billing agency is bonded and/or insured in amounts satisfactory
to the Borough of Paramus.
B.
A
detailed listing of patients who utilize emergency medical services
provided by the Paramus Division of Emergency Medical Services will
be compiled by the Borough of Paramus. 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:
(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 of the patient, when possible, or authorized decision maker.
(9)
Name of receiving physician.
(10)
Names, titles, and signatures of ambulance personnel, when possible.
C.
The
third-party billing agency shall obtain the information from the Paramus
Division of Emergency Medical Services and will bill the patient and/or
their 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 Paramus resident for
any fee, balance, deductible, or copayments not satisfied by public
or private insurance including Medicare/Medicaid, nor will the Borough
bill a Paramus resident for emergency medical services provided if
the resident is not covered by private or public insurance.
D.
The
fee for emergency medical services shall be $950 plus $20 per mile
per trip. Non-transports, where aid is provided, shall be billed at
a rate of $350.
[Amended 2-21-2017 by Ord. No. 2017-03; 2-5-2019 by Ord. No. 19-02]
E.
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 Emergency Preparedness Coordinator and the Chief Financial Officer, and in accordance with the federally approved Medicare Fee Schedule.
F.
The
Borough of Paramus may, in its discretion, bill additionally for material,
vehicle, and personnel costs in the case of major or unique incidents.
G.
The
Emergency Preparedness Coordinator may promulgate rules and regulations
pursuant to and not inconsistent with this chapter, state and federal
law, such rules and regulations, which rules and regulations shall
become effective upon approval by resolution of governing body of
the Borough of Paramus.
