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HomeMy WebLinkAbout35-City Clerk .. . CITY OF SAN BERnARDINO - REQUES'~OR COUNCIL ACTIOt From: Lee Gagnon, Business Registration Supervisor Subject: Bureau of Franchises Report Alleged Double Billing Practices for Paramedic Services Dept: Ci ty Clerk Date: May 13, 1992 Synopsis of Previous Council action: January 21, 1992 The Bureau of Franchise was directed to review and investigate the alleged practice of double billing for paramedic service and take whatever action is appropriate to stop such double billing; further, that the Franchise Bureau report back to the Mayor and Common Council as soon as possible the results of their findings and recommended action. April 20, 1992 Matter was continued to Council meeting of May 18, 1992. Recommended motion: That the Mayor and Council, pending outcome of present litigation, direct staff to include the following on all billings rendered by the City of San Bernardino and Courtesy Services for paramedic services: 1) a description of each level of service provided by each entity, Courtesy Services or the City of San Bernardino; and 2) that the following sentence be added to every billing: "The City of San Bernardino and Courtesy Services may be providing similar paramedic services. If a patient receives two bills for the same service there may be an error. Any billing problems should be directed to ABC Billing Service." ife- . 0;: ~rfr~?~~ Contact person: Lee Gagnon Phone: 384-5036 Supporting data attached: Yes Ward: N/A FUNDING REQUIREMENTS: Amount: N/A Source: (Acct. No.) (Acct. Descriotion) Finance: Council Notes: Aaenda I tem No 35 ~ .- CITY OF SAN BERhrtlRDINO - REQUEST .~OR COUNCIL ACTION STAFF REPORT At their meeting of May 12, 1992, the Bureau of Franchises recommended that the attached report identified as "Exhibit "A" be submitted to the Mayor and Common council. The report is a culmination of investigations conducted by the Bureau of Franchises beginning February 11, 1992 and concluding with the Bureau of Franchises meeting of May 12, 1992. The attached report contains specifics with respect to what has transpired over the previously mentioned time period. Bill Payne, Chairman of the Bureau of Franchises will be present at the Council meeting to answer any questions. 75-0264 CITY OF SAN BERNARDINO Office of the city Clerk INTEROFFICE MEMORANDUM TO: Mayor and Common council FROM: William Payne, Chairman-Bureau of Franchises SUBJECT: Alleged Double Billing Practices for Paramedic Service DATE: May 12, 1992 COPIES: ----------------------------------------------------------------- On January 21, 1992, the city council directed the Bureau of Franchises to "review and investigate the alleged practice of double billing for paramedic service and take whatever action is appropriate to stop such double billing; further, that the Franchise Bureau report back to the Mayor and city council as soon as possible the results of their findings and recommended action." At their regularly scheduled meeting of February 11, 1992, the Bureau of Franchises heard Legal Counsel for Courtesy Services and Legal Counsel from the City response to the double billing issue. At this meeting the Bureau of Franchises set a public hearing for March 10, 1992 at 2:00 p.m. in the council Chambers. At the open public hearing of March 10, 1992, Courtesy services, the City and the public presented their concerns relative to the billing issue. While all comments were well meaning, not all were germane to the billing issue. Most of the public comments indicated support for the Fire Department and displeasure with the high cost of ambulance transportation. At the conclusion of the public hearing Chairman Bill Payne appointed a subcommittee consisting of himself and board members Mr. pensiero and Dr. Curlin to further investigate the alleged double billing practices. The board was charged with the responsibility to meet with both the Fire Department and Courtesy services. On March 27, 1992, the Bureau of Franchise subcommittee met with Chief wright of the Fire Department. Chief wright stated that the Fire Department is carrying out the direction of the Mayor and Common council with the Pay for Paramedic Service Program. While the billing is being handled by an outside firm, "ABC BILLING", it is apparent there are no monitoring devices in place to catch inadvertent "double billings." Basically any remedy is a "knee jerk" reflex based upon complaints. Chief Wright stated there are adequate City Paramedics to handle virtually all calls. During a meeting on May 6, 1992 with Courtesy Services, it was learned that Courtesy handles their own billings without the aid of outside services. The billing process starts with the dispatcher and then continues with the staff that provides the services. There are several steps that a bill goes through before it is mailed. There appears to be monitoring devices in place to avoid the majority of mistakes inherent when a large number of patients are involved. There is a billing procedure in place with prescribed time tables depending on the situation and insurance coverage carried by the individual receiving the service. The accounts receivable are a critical factor to any private employer that has a payroll and expenses to be met. If Courtesy responds with a Paramedic equipped unit to a call they will charge the ALS rate as allowed by I.C.E.M.A. and the County of San Bernardino, even though the city provides the Paramedic service. They will not charge the "All Inclusive ALS" if the City renders the service or if both provide the service unless the City turns over the patient to Courtesy. See attached letter dated February 14, 1986, from George R. Pettersen, M.D. Courtesy Services feels they are entitled to bill for Advanced Life support or ALS service in addition to the City's Paramedic Service because they are given that right by the County Health Officer and I.C.E.M.A. regulations. The subcommittee believes the issues have become so complex that they do not have the ability presently to solve the problems with the pending litigation. It is the subcommittee's belief that both sides have adopted a defensive posture due to the pending litigation, unfortunate innuendos and adverse publicity. It is thus recommended that, at least as an interim measure, all billings of City and Courtesy include a footnote describing the different levels of service in "plain talk" such as "paramedic at scene," "paramedic at scene and ride with ambulance" for city's two levels of service and "scheduled ambulance transport," "emergency ambulance transport" and "emergency ambulance transport with paramedic service" for Courtesy's three levels of service. Also add a sentence below the footnote. "Note that the city of San Bernardino and Courtesy Ambulance may provide similar paramedic services. All efforts are being made to make sure they are not duplicated and you are not billed for any duplication. If you have been billed by the city for "paramedic at scene and ride with ambulance" and by Courtesy for "emergency ambulance transport with paramedic service," there may be an error and you can call ABC Billing Service at to resolve the problem." The cost of ABC's handling of these problems should be negotiated and shared equally by the city and Courtesy. The Bureau of Franchise believes this issue is having a counter productive effect on both sides with citizens of the City of San Bernardino being caught in the middle. It would appear that once the litigation has given both sides a more definitive role, a solution can be negotiated. If the Mayor and Common council then desires, the Bureau of Franchises would move forward to work out a ~~~t~~s could co-exist for the betterment of the William Payne Information to supplement the Subcommittee findings which were submitted on April 7, 1992. Courtesy ambulance handles their own billings without the aid of outside services. The billing process starts with the dispatcher and then continues with the staff that provides the services. There are several steps that it goes through before it is mailed. There appears to be monitoring devices in place to avoid the majority of mistakes inherent when people are involved. There is a billing procedure in place with prescribed time table depending on the situation and insurance coverage carried by the individual receiving the service. The accounts receivable are a critical factor to any private employer that has a payroll and expenses to be met. Understandably any bill that arrives after a medical crisis might be considered to be callous but the fact remains both the City and the Ambulance service must bill in a timely manner. The charge for night surcharge--the night shift for Courtesy is paid a slightly higher rate than the other shifts--weekend shifts are paid the same rate as during the week. This charge is allowed by Medicare and is used in some degree to offset the contractual disallowance from the likes of Medi-cal. ~ The ch~rge for rigid collar is not charged when the collar is reused. The ,records compiled by Courtesy would indicate they used 1234 collars in 1991 and billed for 432. Courtesy has 7 crews that work 24 hour shifts and 13 crews that work 10 hour shifts. The' starting salary for a Paramedic is $30,000 with the benefit package it comes to $39,000 per year. The average Paramedic is making $32,000. If Courtesy responds a Paramedic equipped unit to a call they will charge the ALS rate as allowed by I.C.E.M.A. and the County of San Bernardino, even though the City provides the Paramedic service. They will not charge the "All Inclusive ALS" if the City renders the service or if both provide the service unless the City turns over the patient to Courtesy. (See attached letter from Director of Public Health) Billings coming from ABC for the City indicate the charge as being ALS Transportation $200 and Ambulance Transportation $100. One bill to Medicare, that doesn't pay for Paramedic service, would appear to be using the City of San Clemente's ambulance number which is required to be able to bill. The City doesn't have an ambulance or a number to able to bill. There may be some problems with regard to waiving the deductible and 20% charge on Medi-care billings which might be illegal. Courtesy Service feels that it has been without a rate increase since 1989, it's cost have risen by 23%, they have ceased to charge for All Inclusive ALS and in addition have refunded or failed to charge approximately $10,000 in a large part for good will. They agree that the wording on their bills is confusing and the terminology can be offensive to the average person who does not understand who is providing what service. The revamping of terminology and more informative billings are being initiated. The condition of "Double Billing" is brought about by confusion on both sides as to what service is being rendered under what circumstances. ,I -; _ "; ~ '" u ". .I."""~'::>' (.EC.;.Cf. a. Hl'rE"'~El". M.D., M.P.H. DF.P ARTMENT Or' rUBT.lC HEi\J.TH ~;.~'1cr or P...b'~ l~.o\h" ..,_... __.... .._.___,_.- .._ _' . .. . _.... .... .._. .' .._' . . ... .u....-.. -" - - _.. _." ..-. -" . -. .. ....--.. ,~\\,11/~/ '~t~.;' ..,:: ~... ~- - ..,. .::- ~~ ~'" /~iJ/ll\~\~' County of S:lll Bernardino t _: " i ..~ , . ... .. . ..... ... ~~I ,"""",,\ 1.41, ViC'N A...(1';~C Sa.n Bttt.lJeino. CA SH: H/J10 C' 14) ~n-"Cl FRO,.,: February 14. \986 n;()~ GEORGE R. pnTERsENJ~.D.. Director of Public Health CA1'E: TO': ALL AI1BUlI~NCE PROVl DERS stJaJECT: AM6UlA:~CE AAiES In my ~Iemo of January 28.. 1986 I informed you th~t the San Bernardino County 9o~rd of Supervisors amended the rcgulatior,s end established.~ categOry colled Advanced Life Support. 1his rate waS set at $205.pO. There shDuld be no conf~sion as to when that rate will applY. It ;s inten~ed to apply when there ;s a specific request for' parlmcdic services or staffing- It is also intended to apply .when paramedics 3re staffing an ambulance unit that responds to all tl:len:)e!\cy ca" even though they do not prov; de illS s ervl ces · It is not intended to apply during sCheduled, non urgent transport when EKT-I's cou1d appropriate'Y have staffed ...he unit even thou!;" a yar6medic un1t w~s dispatched. Another situation has arisen which needs clarificaticn relating to nights and weekends. The adcitional charge of $39.34 is intended to be applied between the hours of 7:00 p.m. and 7:00 a.~. or at any hour rlurl n9 t"e weekend period. This doeS not 1lIJan that both charges a?p1y during the night on a weekend. The regulation s?ecifically states one or the other not bolh. P1ease inform your billing personnel of these two interpretations. G~P : bh .t..-.., _.1 ....... "".'L " ". ,,,\ .:". ' I- _, ,\ ~;!,...' I · . , 1,...1 : o. ..."' ... ,~u '.' ,; : I ,,'.. "~ ' "..... :'. '" _ 0 ; . ;'" : l; 1" ." ' ...1.... .'~'. 'o'!~ . i.-' ......',. . '. . ;. ,'1 ..' . . I. ....1 t., II . . .,. ,., '" : . t.. ; t " . "O!:. '. . . .... ......._~ .... ..._.. . _.. .e CITY OF SAN BERt~ '~RDINO - REQUEST ~R COUNCIL ACTION From: Lee Ga~, Business Registration Supervisor Subject: Bureau of Franchises Reoort Alleged Double Bi11inp Practices for Pararredic Services l City Clerk Date: April 8, 1991 Synopsis of Previous Council action: January 21, 1992 The Bureau of Franchise vlas directed to review and investigate the alleged practice of double billing for paramedic service and take whatever action is appropriate to stop such double billing; further, that the Franchise Bureau report back to the Mayor and City COlmCi1 as soon as possible the results of their findi.ngs and recarmended action. Recommended motion: Report to follow \ " - /// ~~ :.~. L- ..,/ "L- c/ ~~~.~~~ Signature -- Contact person: Lee Gagnon Phone: 384-5036 N/A Supporting data attached: m Ward: FUNDING REQUIREMENTS: Amount: N/A Source: (Acct. No.) (Acct. Descriotion) Finance: C I Notes: 75-0262 LJ - Q n _ q~ ..#'" I') L ~ - 1 ~ - 97 Aaenda Item NO" .3 S C I T Y 0 F SAN B ERN A R DIN 0 INTEROFFICE MEMORANDUM CITY ADMINISTRATOR'S OFFICE DATE: May 15, 1992 TO: Mayor and Common Council FROM: Peggy Ducey SUBJECT: Bureau of Franchises Report COPIES: Shauna Clark On January 21, 1992, the Mayor and Common Council directed the Bureau of Franchises to investigate the alleged practice of double billing for paramedic services. The Bureau held a number of meetings and public hearings to research the issue and has completed a report to the Mayor and Council. The issue of double billing hinges on Courtesy's position that they are permitted by the County Health Officer to charge for paramedic services, or Advanced Life Support (ALS), when an ALS ambulance responds to a medical call, even when paramedic care was rendered only by the city. The Bureau has recommended that the City withhold any strong action pending the outcome of the present litigation. However, it seems apparent that no matter what the outcome of the lawsuit, the losing party will appeal and a definitive answer will not be available for some time. In the meantime, citizens will continue to receive bills from Courtesy Ambulance for paramedic services that are not actually provided by them. Currently, the city averages 1,000 medical aid calls per month. Approximately half result in ambulance transport, with these patients receiving a paramedic bill from both the City for $200 and from Courtesy Ambulance for $275 400. Often, insurance companies will not pay both paramedic charges, and the patient is forced to pay one of these fees out of pocket. It is staff's position that San Bernardino citizens should not have to pay for services that they do not actually receive. RECOMMENDATION It is recommended that the City Council refer the recommendation of the Franchise Bureau to the Legislative Review Committee and direct staff to negotiate a franchise agreement with Courtesy Ambulance which clearly specifies the conditions that ambulance service will be provided in the City. The agreement would delineate ambulance deployment and authorized fees. This agreement would ensure that ~36 ~th parties have a clear understanding of their rights, roles, and ~sponsibilities, and should reduce conflict in the field. ? PEGGY DUCEY Assistant to e City Administrator