19-R-102 - EMS Charity Care PolicyRESOLUTION NO. 19 -R -102
A RESOLUTION BY THE CITY COUNCIL OF THE CITY OF
SCHERTZ, TEXAS APPROVING THE SCHERTZ EMS CHARITY CARE
POLICY
WHEREAS, the City of Schertz EMS provides ambulance services to the City of Schertz
and other surrounding communities and emergency services districts; and
WHEREAS, The City of Schertz EMS has been participating in the Texas Ambulance
Services Supplemental Payment Program (TASSPP) since 2015; and
WHEREAS, The Centers for Medicare and Medicaid Services requires a charity care
policy to continue participating in TASSPP; and
WHEREAS, the City Council has determined that it is in the best interest of the City to
have a charity care policy.
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF SCHERTZ, TEXAS
THAT:
Section 1. The City Council hereby approves the City of Schertz EMS Charity Care
policy.
Section 2. The recitals contained in the preamble hereof are hereby found to be true,
and such recitals are hereby made a part of this Resolution for all purposes and are adopted as a
part of the judgment and findings of the City Council.
Section 3. All resolutions, or parts thereof, which are in conflict or inconsistent with
any provision of this Resolution are hereby repealed to the extent of such conflict, and the
provisions of this Resolution shall be and remain controlling as to the matters resolved herein.
Section 4. This Resolution shall be construed and enforced in accordance with the
laws of the State of Texas and the United States of America.
Section 5. If any provision of this Resolution or the application thereof to any person
or circumstance shall be held to be invalid, the remainder of this Resolution and the application
of such provision to other persons and circumstances shall nevertheless be valid, and the City
Council hereby declares that this Resolution would have been enacted without such invalid
provision.
Section 6. It is officially found, determined, and declared that the meeting at which
this Resolution is adopted was open to the public and public notice of the time, place, and subject
matter of the public business to be considered at such meeting, including this Resolution, was
given, all as required by Chapter 551, Texas Government Code, as amended.
Section 7. This Resolution shall be in force and effect from and after its final
passage, and it is so resolved.
50234811.1 A -1
PASSED AND ADOPTED, this 27th day of August, 2019.
A EST: ,
Y secretary
50234811.1
CITY OF SCJJ�-, TEXAS
A -2
R. Carpenter, Mayor
Schertz EMS Billing Policy
Schertz EMS is committed to providing the best care to patients in the cities that we serve. Our fees
include a base charge for the transport and a mileage fee. These fees are approved annually by Schertz
City Council. Schertz EMS accepts assignment from all third -party payers. We will make every attempt to
bill and collect from the patient's insurance company. Medicare, Medicaid and most commercial
insurance cover ambulance transportation that is medically necessary. Insurance companies pay claims
based on the type of coverage each individual policy provides. Schertz EMS does not have contracts with
insurance companies; therefore we do not waive the unpaid portion of the bill which includes the co -pay,
co- insurance or the deductible.
Fees
Response Services
Aid Call $ 200.00
Air Medical Assist Call
$ 700.00
BLS Non- Emergency
$1,090.00
BLS Emergency
$1,210.00
ALS Non - Emergency
$1,230.00
ALS Emergency No Specialty Care
$1,440.00
ALS Emergency W 1 Specialty Care
$1,600.00
Mileage, per mile
$ 20.00
Passport to Care Subscription Program
Oftentimes insurance companies deny payment for specific services or will only cover a portion of the
fees actually billed. In order to offset the cost of ambulance service charges, Schertz EMS offers an
opportunity of enrollment in our ambulance subscription program. For a nominal annual fee per year, per
household, subscribers will be covered from out of pocket expenses such as deductibles and co- payments
or from services not covered by insurance companies.
Passport _to Care Subscription Rates
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Insured
Not Insured
Single
$50.00
$65.00
Family
$60.00
$75.00
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CHARITY CARE POLICY:
The City of Schertz EMS Department may provide healthcare services to patients without the expectation
of reimbursement (charity care services) if the patient meets the charity care guidelines below, and is
determined to be eligible to be a charity care patient. Charity care services do not include bad debt,
payment shortfall(s), insurance allowances, courtesy allowances, or reductions given to patients who do
not meet the provider's charity care policy or financial assistance policy.
Charity care services become effective as of October 1, 2019, and will only be available as long as the State
of Texas provides reimbursement for charity care services through the Texas Ambulance Services
Supplemental Payment Program /Medicaid 1115 Waiver, or similar means of reimbursement.
The City of Schertz EMS Department may change the charity care determination criteria under Section 2.
II. on a regular basis and will maintain the current criteria.
CHARITY CARE POLICY GUIDELINES:
1. The City of Schertz EMS Department must determine each patient's ability to pay for the ambulance
services provided before classifying the patient as a charity care patient. If the patient does not have the
ability to pay for the ambulance services, the City of Schertz EMS Department may determine the patient
as a charity care patient.
To determine a patient's ability to pay, the City of Schertz EMS Department shall:
I. gather patient information during and /or after the services are provided, as applicable given the
patient's condition. This may include the issuance of one or more requests for information with
the patient to obtain information necessary forthe City of Schertz EMS Department to determine
the patient's ability to pay for the ambulance services provided. During communication with a
patient, the City of Schertz EMS Department shall include information about its charity care
services;
II. undertake an insurance discovery process to identify if the patient has third party insurance
including Medicaid, Medicare, or other forms of insurance; and,
III. undertake reasonable collections efforts to verify and /or yield essential information about the
ability of the patient to pay for the ambulance services provided.
2. The City of Schertz EMS Department may classify the patient as a charity care patient if the following
occur:
The current revenue cycle process results in one or more of the following:
a. the patient does not provide evidence of insurability, or the City of Schertz EMS Department is
unable to obtain information from the patient during the requests for information in 1. I. within
a 30 -day period. The lack of a response by the patient may be considered an affirmation that the
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patient does not have third party insurance and does not have the ability to pay for the ambulance
services provided;
b. the insurance discovery process in 1. II. determines that the patient does not have a third party
insurance product that will pay for the ambulance services provided. The lack of insurance or
having an insurance product that does not pay for ambulance service may be considered by the
City of Schertz EMS Department as a determinant that the patient does not have third party
insurance and does not have the ability to pay for the ambulance services provided; or,
c. the collections effort in 1. Ill. results in no payment, or minimal payment, from the patient over a
30 -day period. Receiving no payment or minimal payment from the patient may be considered by
the City of Schertz EMS Department as a determinant that the patient does not have third party
insurance and does not have the ability to pay for the ambulance services provided;
II. The payment predictor model indicates that a patient does not have a high likelihood of payment
as identified by the following classifications:
a. results indicate a low, medium, or non - classified designation
1) low designation results are identified as "L" (red)
2) medium designation results are identified as "M" (yellow)
3) non - classified designation results are identified as "NC" (red) and indicates that there is
insufficient patient information to adequately determine likelihood of payment, thus
indicating a low likelihood of payment
3. The City of Schertz EMS Department may also classify the patient as a charity patient if:
The service to an insured patient is denied by the insurance provider as not covered;
II. The City of Schertz EMS Department is notified that the patient has been granted charity care by
the sending or receiving hospital; or,
III. The City of Schertz EMS Department is notified that the patient is deceased and there are no
additional remedy options that may be pursued.
4. Once the City of Schertz EMS Department determines the patient is a charity care patient, the City of
Schertz EMS Department will make no further attempts to collect from the patient.
5. The ambulance services provided to the charity care patient shall be valued at 100% of the net cost of
providing those services by the City of Schertz EMS Department.
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Payment Plans
Schertz EMS will accept payment plans if the need arises. A minimum of $25 per month will be accepted
on a case by case basis. Payment plans will be setup with the EMS Billing Department.
Prompt Payment Reduction
A prompt payment reduction of 25% will be offered to those who receive an invoice, after insurance
applies payment, and make payment in full within 30 days of the invoice date.
Collection Agency+
Patients will be sent to collections after 105 days of non - payment or non - response. The collection agency
will attempt to collect the debt with an additional 30% fee included with the amount owed.
Billing Adiustments
Bills of homeless patients who we cannot locate and deceased patients who do not have insurance or
estates from which to recover EMS charges will be adjusted based on the charity care policy. Insurance
and attorney requests for adjustments will be on a case by case basis.
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