Borough of Ridgefield, NJ Chapter 27A Emergency Services

[HISTORY: Adopted by the Mayor and Council of the Borough of Ridgefield 5-28-2013 by Ord. No. 2230. Amendments noted where applicable.]

§ 27A-1 Recognition of services provided.

The Borough hereby recognizes that it provides certain emergency medical and ambulance transport services to persons both within and without the Borough of Ridgefield at great cost and expense to the Borough of Ridgefield.

§ 27A-2 Authorization to bill.

The Borough hereby determines that it should exercise the power and authority to charge for the emergency medical and ambulance transport services it provides, and to render bills in connection with the delivery of these services, to individuals receiving these services upon the terms and conditions set forth in this chapter.

§ 27A-3 Billing regulations.

The Borough hereby establishes the following regulations and provisions in connection with the delivery and billing for emergency medical and ambulance transport services:

A. No person requiring emergency medical services and/or ambulance transport services shall be denied services due to lack of insurance or lack of ability to pay the appropriate charges.

B. The Borough shall obtain all necessary licenses from the New Jersey State Department of Health, or otherwise, and shall apply for a provider number from the federal and state Medicare/Medicaid programs, and otherwise take such steps necessary to allow it to bill for the emergency medical and ambulance transport services.

C. All patients, whether or not a legal domiciliary of the Borough of Ridgefield, and/or their financially responsible parties, insurers or carriers, will be billed for emergency medical and ambulance transport services provided by the Borough of Ridgefield according to a fee schedule established by the Mayor and Council of the Borough of Ridgefield. The Borough will bill for emergency medical and ambulance transport services rendered by its paid CSO officers and by members of the Borough's Volunteer Ambulance Corps.

[Amended 4-19-2017 by Ord. No. 2320]

D. A patient who receives emergency medical and ambulance transport services from the Borough of Ridgefield is obligated, at the time of service or as soon as practicable thereafter, to provide the Borough with all pertinent identification, insurance and/or 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 accept payment on an assignment basis.

E. All patients who are not legally domiciled in the Borough of Ridgefield 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 co-insurance 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 individual legally domiciled in the Borough of Ridgefield for any fee, balance, deductible, or copayments not satisfied by public or private insurance, including Medicare/Medicaid, nor will the Borough bill an individual legally domiciled in the Borough of Ridgefield for emergency medical services provided if that individual is not covered by private or public insurance for the charges.

G. The Borough of Ridgefield 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 parties for installment payments of bills or forgive any bill or portion thereof, so long as the Borough determines that: 1) the financial condition of the patient requires such an arrangement; and 2) the patient and/or financially responsible party has demonstrated a willingness to make good-faith efforts towards payment of the bill.

H. A patient who has received emergency medical or transport services from the Borough of Ridgefield, including an individual legally domiciled in the Borough, for whom the Borough of Ridgefield 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 Borough, is obligated to remit such monies to the Borough in the event that 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 Ridgefield shall be authorized to enter into contracts with area hospitals that provide advanced life support (ALS) services to patients that are transported by the Borough. This will allow the hospitals to bill for all emergency medical services and, if so agreed, timely reimburse the Borough for its transportation costs within 45 days of receiving payment.

§ 27A-4 Procedure for third-party EMS billing.

A. The Borough of Ridgefield 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 the 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 Ridgefield.

B. A detailed listing of patients who utilized emergency medical services and/or transport provided by the Borough of Ridgefield will be compiled by the Borough. 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 pickup 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 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 Borough of Ridgefield and will bill the patient and/or the patient's 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 individual legally domiciled in the Borough of Ridgefield for any fee, balance, deductible, or copayments not satisfied by public or private insurance, including Medicare/Medicaid, nor will the Borough bill an individual legally domiciled in the Borough of Ridgefield for emergency medical services or transport provided if that individual is not covered by private or public insurance.

D. Fees for emergency medical services. The fees for emergency medical services, transport miles per trip and nontransports where aid is provided shall be as follows:

(1) Base rate for emergency ambulance transport: $750.

(2) Additional mileage charge for emergency ambulance transport: $14.

(3) Ambulance response, treatment refused (RMA): $250.

(4) Ambulance response, patient deceased (DOA): $750.

E. The Borough reserves the right to bill additionally for material, vehicle and personnel costs in the case of a minor or unique accident.

F. 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 Chief of Police, or his/her designee, the Captain of the Ridgefield Volunteer Ambulance Corps and Chief Financial Officer and in accordance with the federally approved Medicare fee schedule. .

[Amended 4-19-2017 by Ord. No. 2320]

G. The Borough of Ridgefield may, in its discretion, bill additionally for material, vehicle, and personnel costs in the case of major or unique accidents.

H. The Chief of Police, or his/her designee, and the Captain of the Ridgefield Volunteer Ambulance Corps may promulgate rules and regulations pursuant to and not inconsistent with this section, state law and federal law, such as rules and regulations, which rules and regulations shall become effective upon approval by resolution of the governing body of the Borough of Ridgefield.

[Amended 4-19-2017 by Ord. No. 2320]