§ 19-58. Emergency medical service (EMS) payment policy.

(a)

Definitions.

(1)

Responsible party. Person or entity that is legally liable for the cost of the medical debts of the patient. In most cases, the responsible party is the patient or a legal guardian.

(2)

Contractual write-off. Any amount of the EMS bill that the city by contract or agreement has agreed to discount its fees.

(3)

Transportation consent form. Patients are required, if able, to sign a consent form acknowledging consent for treatment, provide authorization to submit a bill on the patient's behalf, assign benefits to the city allowing insurance payment directly to the city.

(4)

Uninsured patients. Any patient treated that does not have any form of medical insurance to cover any portion of the ambulance service. A patient is considered uninsured for ambulance billing if they have a medical insurance policy that excludes or does not provide reimbursement for ambulance transportation.

(5)

Non-medically necessary transport. Any transport that does not meet the Center for Medicare/Medicaid Services (CMS) criteria for transportation by ambulance. CMS is the sole determining factor for determining medical necessity. Medicare has two definitions for medical necessity 1) emergency and 2) non-emergency:

a.

Medical emergency. Medicare defines as a "sudden onset of a medical condition of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the beneficiary's health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any body organ or part.

b.

Non-emergency medical transport. CMS requires that a beneficiary's condition contraindicates any other form of transportation. That is the beneficiary must be "bed confined" and the doctor or other medical professional must certify that ambulance transport was medically necessary.

1.

Bed confined. Must meet all the following criteria:

Patient is unable to get up from bed without assistance; and

Patient is unable to walk; and

Patient is unable to sit in a chair or wheelchair.

(b)

Patient financial responsibility. The patient by using the city's EMS services has incurred a legal debt for services rendered. The debt is legal even if the patient did not summon EMS services, but used the service. The patient or responsible party is liable for all fees associated with providing EMS services from the city. The patient is responsible for payment if a transportation consent form was not able to be signed.

(c)

Contractual write-offs. The city will follow and adhere to all contractual agreements with insurance providers, both private and governmental (Medicare/Medicaid), to "write-off" balances. Patients will not be responsible for contractual write-off amounts.

(d)

EMS fees. EMS fees are set by city council and are adjusted periodically to reflect the Medicare/Medicaid set rate rounded up to the nearest whole dollar. For those items/supplies not set with Medicare/Medicaid rate the city manager shall set a fair market rate to include a cost analysis and cost of intervention and cost of administration. Fees are a matter of public record and are available from normal municipal information channels.

(e)

Insurance reimbursement. The city, as a courtesy to patients, will submit for insurance reimbursement.

(1)

The patient is responsible to ensure that the city has all information needed to submit and receive timely payment from insurance carriers.

(2)

The city's submission of insurance does not release the patient from the legal responsibility of the debt.

(3)

If the patient's insurance company does not provide payment within one hundred eighty (180) days of claims submission, the patient will then become responsible for the amount due. It will then be the patient's responsibility to recover from the insurance company.

(f)

Deductibles, co-pays, etc. The patient is responsible for any deductibles, co-pays, and non-covered portions of the fee. A statement will be mailed to the patient reviewing account status. However, the patient is responsible for providing accurate information to the city so statements can be properly mailed.

(g)

Payments. Payments may be made to the city at its designated address.

(1)

Mailed payments may only be personal check, certified check, money order, or credit card. Cash payments are not accepted through the mail.

(2)

Cash payments may be made at the Eagle Pass Fire Department Office located at 2558 El Indio Highway, Eagle Pass, Texas 78852.

(3)

The city's billing agent accepts Visa, Master Card, and American Express credit cards for payment.

(h)

Payment plans. If the patient demonstrates an inability to pay the entire bill on time in lump sum, a payment plan may be established with the following parameters:

(1)

Minimum payment is the greater of twenty dollars ($20.00) or five (5) percent of the total bill.

(2)

Payments will be agreed upon amounts and duration.

(3)

Any payment plan may not exceed twenty (20) months in duration.

(4)

The city will not impose interest or fees on payment plans.

(5)

Any payments over thirty (30) days late will cause the payment plan to be cancelled and full payment due immediately.

(6)

The patient will receive a monthly statement as a reminder.

(i)

Small balance write-off. Any patient balance of ten dollars ($10.00) or less may be written off as uncollectible after ninety (90) days from receipt of last payment, with no consequence to the patient.

(j)

Collections. Any patient that has a balance greater than ten dollars ($10.00) and who has not made a payment or attempted to contact the city or its billing agent for one hundred eighty (180) days from last payment may be turned over to a collection agency to recover the outstanding debt. The collection agency may report the unpaid debt to credit report agencies.

(k)

Deceased patients. If a patient is deceased, then the estate is responsible for any outstanding bills. Upon presentation of a death certificate and an accompanying statement that the patient has no probated estate, the account debt may be dismissed.

(l)

Uninsured patients.

(1)

The city will accept as full payment from city residents who are uninsured the amount that Medicare would have paid, if the patient was insured by Medicare upon submittal of an affidavit of no insurance (Exhibit 1) along with a request for relief of ambulance charge (Exhibit 2). Upon approval, the patient's account will be adjusted.

(2)

If the patient has a fiscal hardship, a payment plan may be approved as outlined in subsection (h).

(3)

If the patient has been determined as indigent by any bona fide agency within Maverick County, account will be written off except for any out of pocket payment as required by said agency. Patient must submit indigent form in order to receive this benefit.

(Ord. No. 07-29, § 1, 12-11-2007; Ord. No. 2016-29, § 10, 9-20-2016)

Editor's note

Ord. No. 07-29, § 1, adopted Dec. 11, 2007, set out provisions intended for use as § 19-55. To preserve the style of this Code, these provisions have been included as § 19-58 at the discretion of the editor. Subsequently, it should be noted that Exhibit 1 and Exhibit 2 are not set out herein but are on file in the offices of the city.