Manatee County Government Administrative Center Commission Chambers, First Floor 9:00 a.m. - February 23, 2016
February 23, 2016 - Regular Meeting
Agenda Item #34

Write Off Uncollectible EMS Ambulance User Fees - December 2015


Contact and/or Presenter Information
Mary Allred, Records Coordinator, EMS Business Operations, x1681.
Christine Bowling, Manager, EMS Business Operations, x7874.
Authorized by Robert Smith, Director, Public Safety, x3511.

Action Requested
Authorization for Public Safety Department to remove uncollectible accounts for ambulance user fees totaling $341,896.96 from the active accounts receivables in accordance with generally accepted accounting principles.

Enabling/Regulating Authority
Resolution R-13-196, Section Three: Adjustment of EMS user fees, Subsection G, Adjustment of Accounts Receivable. Florida Statutes Chapter 125--Home rule authority.

Background Discussion

Emergency Medical Services (EMS) Billing Practices

Manatee County Emergency Medical Services (EMS) responds to more than 45,000 calls for service each year and transports thousands of distressed patients to local hospitals to receive emergent care. Manatee County EMS enjoys a 67 percent collection fee rate, meaning two-thirds of our transport billable is collected. Over time Manatee County has refined its billing standards and improved our ability to collect transport fees. Today, Manatee's 67 percent collection fee rate easily exceeds industry standards which fluctuate between 35 percent and 45 percent. A majority of ambulance transportation fees are paid by a patient's medical insurance, or by the patient directly. For patients with insurance, Manatee County EMS issues an initial transport claim to the patient's insurance company; this is followed up in 45 days with a second claim notice. Once the billable (the County's claim) reaches 45 days, the insurance company and the patient are both sent a bill for transport service. If the transport bill is not paid or if a payment plan cannot be agreed upon within the next 30 days by either the patient's insurance company or the patient, the billing claim is forwarded to a contracted collection company. If the patient does not have insurance coverage, the transport bill for ambulance services is sent directly to the patient who then has 30 days to make a payment to Manatee County. Self-pay patients are sent four statements, about 30 days apart. Most self-pay patients are encouraged to set up and participate in monthly payment plans. Manatee EMS recognizes that not all patients have the ability to pay for the service, but we must ensure the safety of our community through these responses.

Uncollected Charges

The majority of uncollected charges involve: Patients who are unable to pay the cost of the service; International patients who provide an unverifiable billing address; Patients who provide an unverifiable local address or bad address; Patients addresses who have no mailbox or Post Office box; Patients who have moved and left no forwarding address; Patients who fail to meet their co-pay to Manatee County after their insurance makes the transport payment; Patients who have a large insurance deductible, and are unable to pay that deductible. For accounting purposes, each month Manatee County must resolve these unpaid balances. As a result, the Manatee Board of County Commissioners is asked to write-off the uncollectible billing amounts. Write-offs are not debt forgiveness, but a standard accepted accounting practice which local governments use to remove these account types. To be clear, the County is not waiving its right to collect the fees and continues to task its collections agency with recouping unpaid balances. To the greatest extent possible, the County prefers to ask those who use the ambulance service to pay for it. When patients cannot afford to pay EMS fees, property owners must cover the expense in the form of property taxes. The County occasionally receives requests to lower EMS fees, but to do so would increase the County's reliance on property taxes to support ambulance services. For more information please visit a list of Frequently Asked Questions about EMS billing here: http://www.mymanatee.org/home/government/departments/public-safety/emergency-medical-services/F-A-Q.html

Manatee County ambulance billing services has been contracted to PST Services, Inc., d/b/a Per-Se Technologies, since March 1, 2005. After PST Services, Inc., has made a reasonable effort to collect on an account, the account is turned over to Professional Recovery Consultants, Inc., the collection agency that has contracted collection services with Manatee County. The accounts are now pursued by the collection agency. PST Services, Inc., removes the accounts from the accounts receivable ledger as an uncollectible amount. To maintain consistency and for accounts receivable reconciliation purposes, it is recommended that these amounts also be removed from the active accounts receivable ledger for Manatee County, maintained by the Clerk of Circuit Court Finance Department. Writing these accounts off throughout the year in conjunction with our billing contractor allows a more accurate statement of the County's accounts receivable and does not overstate the value of accounts receivable in the General Fund. Manatee County does not waive any rights it may have to collect.

Uncollectible accounts for ambulance user fees as submitted by Per-Se Technologies as of December 2015 are included in Attachments A and B. Attachment A, fees totaling $340,577.96 from FY2011 - FY2016 are being written off and accounts were sent to the collection agency. Attachment B, fees totaling $1,319.00 from FY2016 are being written off for accounts that are not being sent to the collection agency due to insufficient patient demographics. Attachment C provides details of the EMS adjustment totals for December 2015.

County Attorney Review
Not Reviewed (No apparent legal issues)

Explanation of Other

Reviewing Attorney

Instructions to Board Records
Copy of approved agenda to: robert.smith@mymanatee.org, christine.bowling@mymanatee.orgmary.allred@mymanatee.org, and danielle.heaton@manateeclerk.com.

Cost and Funds Source Account Number and Name

Amount and Frequency of Recurring Costs

Attachment:  December 2015 Attachment A.pdf
Attachment:  December 2015 Attachment B.pdf
Attachment:  December 2015 Attachment C.pdf