The purpose of this article is to establish uniform criteria for the billing of emergency medical services as provided by the City of Allentown EMS.
[Adopted 5-11-2009 by Ord. No. 14702 (Article 391 of the 1962 Codified Ordinances)]
[Amended 12-1-2010 by Ord. No. 14843]
Billing is applicable to the Bureau of EMS Enterprise Fund.
As used in this article, the following terms shall have the meanings indicated:
Advanced life support (ALS) assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service but does allow for an ALS level of payment.
The provision of an ALS assessment by an ALS provider and/or the provision of one or more ALS interventions, unless otherwise defined by the Centers for Medicare and Medicaid Services, in which such definition shall be incorporated herein by reference.
The administration of at least three medications or in some cases allowable multiple doses of the same medications and/or the provision of one or more of the following ALS procedures: Manual defibrillation, cardioversion, cardiac pacing, intubation of the airway, central venous line, chest decompression, surgical airway, or intraosseous line; unless otherwise defined by the Centers for Medicare and Medicaid Services, in which such definition shall be incorporated herein by reference.
A charge to a patient (which may be paid by the patient's insurance in some cases) who has received an ALS assessment or an ALS level of treatment by an EMS provider at a scene, through actual, implied or informed consent, but who has refused transport to a hospital for any reason.
The provision of an advanced level of care and/or resuscitation efforts utilizing advanced skills, medical equipment and/or techniques by an individual who is trained to provide prehospital emergency medical care at the paramedic, nurse or physician level; which includes, but is not limited to: the administration of intravenous fluids, medications, manual defibrillation, pacing, intubation of the airway and cardiac monitoring and/or the skill of providing an advanced life support assessment.
A charge to a patient (which may be paid by the patient's insurance in some cases) who has received an assessment or a BLS level of treatment by an EMS provider at a scene, through actual, implied or informed consent, but who has refused transport to a hospital for any reason.
The provision of a basic level of initial care and/or resuscitation efforts provided by an individual who is trained to provide emergency medical care which includes but is not limited to: CPR, opening and oxygenating the airway, attempting to control external bleeding, applying and operating an AED, bandaging, splinting and other basic skills of the first responder, emergency responders or EMT. (Paramedics, nurses and physicians may also perform BLS skills even though they have a higher level of training.)
Disposable supplies utilized in excess of the customary amount and not exchanged/replenished from hospital stock or billed by the receiving hospital.
A person or persons who have been trained to any recognized level of competency as defined by the Pennsylvania Department of Health, including: ambulance attendant, first responder, emergency responder, emergency medical technician, advanced emergency medical technician, paramedic, critical care paramedic, pre-hospital registered nurse (PHRN), nurse, physician extenders or physician.
The services utilized in responding to those persons presumed to be in need of immediate medical care within the jurisdiction of, and areas adjacent to the City of Allentown, provided by the City of Allentown bureau of Emergency Medical Services or those agencies operating in conjunction with the bureau of EMS.
The application of an automated external defibrillator (AED) used to attempt to convert lethal abnormal electrical heart rhythms.
An additional attendant required to adequately manage patient care on scene or during patient transport.
Distance traveled by an ambulance from the point where the patient is picked up ending at the destination, facility, usually a hospital.
An individual domiciled outside of the City limits of Allentown.
The administration of oxygen for the treatment of conditions resulting from oxygen deficiency.
Person receiving emergency medical services.
The issuance of a bill to the patient or to the party responsible for the patient's personal financial obligations, and subsequent billings, collection letters and telephone calls or personal contacts which constitute a genuine, rather than token, collection effort.
Active utilization of fire department or EMS rescue tools and equipment to facilitate extrication of a patient from an entrapped or access-limited area.
An individual domiciled within the City limits of Allentown.
Inter/intrafacility transportation of a critically injured or ill individual at a level beyond the scope of an paramedic; unless otherwise defined by the Centers for Medicare and Medicaid Services, in which such definition shall be incorporated herein by reference.
The utilization of an ambulance or squad vehicle and one or more EMS providers to stand by at a planned and organized activity, event or contest, where a large group or gathering is expected, when the likely potential for the provision of emergency medical services may exist.
An insurance carrier or other coverage provider having a responsibility or other obligation to pay for medical services rendered to a patient as a result of that patient's accident, injury or illness.
A.
The City recognizes the need to bill for these services to aid in the provision of emergency medical services.
B.
No person requiring emergency medical services shall be denied service due to a lack of insurance or ability to pay.
C.
All patients, whether or not domiciled in the City, and/or their financially responsible parties, insurers or carriers, will be billed for emergency medical services provided by the City according to the charges established in § 270-53 or at rates established by the City from time to time.
D.
Nonresidents: The City shall make reasonable collection efforts, in some cases according to the most current rules or regulations set forth by the Centers for Medicare and Medicaid Services. The City may bill any applicable coinsurance, copays or deductibles for such amounts not paid by primary insurances, as applicable by law. Exceptions include only those instances where the City has made a determination that the cost of billing and collecting such copayments or deductibles exceeds or is disproportionate to the amounts collected.
[Amended 10-2-2019 by Ord. No. 15566; 6-1-2022 by Ord. No. 15815]
E.
Residents: City residents shall not be held responsible for any balance due for medically necessary transport that is not paid by an insurance carrier with the exception of the deductible and contractual copays as per the residents insurance company as long as said resident complies within 30 business days of the date of billing. If the resident does not respond to the requests within the time frame above, the resident shall be responsible for the amount owed. City residents are responsible for any balance due that is not paid by an insurance carrier for transport deemed not medically necessary by EMS staff beginning with the resident's third use of this service. Exception to these provisions are when City ambulances are not available due to resource depletion based on heavy call volume and where mutual aid ambulances are substituted to provide EMS services within the City of Allentown. In those cases, City residents may have additional charges above and beyond those paid by insurance based on the billing practices of the mutual aid ambulance service.
[Amended 12-1-2010 by Ord. No. 14843; 10-2-2019 by Ord. No. 15566; 6-1-2022 by Ord. No. 15815]
F.
The City shall not balance bill when prohibited by law.
G.
The City will allow reasonable payment arrangements in the event a patient cannot pay a bill all at once.
[Amended 12-1-2010 by Ord. No. 14843]
H.
A patient who received payment for City EMS bills from a third-party payor is obligated to remit such monies to the City of Allentown (provided that the patient has not paid the bills directly). The City shall hold any patient who does not do so liable for any costs or fees related to the City's expenses of recovering the patient's EMS service fee.
A.
After a patient encounter, the responding EMS personnel will prepare a detailed patient record or chart describing the encounter through a computerized records management system that adheres to state reporting standards. The federal Health Insurance Portability and Accountability Act (HIPAA) shall govern the use, distribution and security of all patient records. This chart of information will be transmitted to the bureau or agency responsible for billing with the following information if available:
(1)
Name and address of patient and guarantor.
(2)
Social security number of the patient and guarantor.
(3)
Name and address of patient and/or guarantor's insurance carrier (if applicable).
(4)
Date, time and EMS run number.
(5)
Point of origin and destination.
(6)
Suspected illness or injury.
(7)
Signature of the patient (when possible).
(8)
Description of service provided.
B.
The billing department will encode the charges as established below based on level of service provided, or by the patient's reported condition at the time of the dispatch:
[Amended 12-7-2016 by Ord. No. 15334; 5-18-2022 by Ord. No. 15811]
Ambulance Service | Amount |
|---|---|
BLS - Emergency | $600 |
ALS1 - Emergency | $920 |
ALS treat no transport | $460 |
ALS2 - Emergency | $950 |
Specialty care transport (SCT) | $1,100 |
Mileage (per loaded mile) | $12.70 |
Rescue service | $940 |
Special event stand-by (per hour) (includes 2 paramedics and 1 ambulance | $160 |
Special event stand-by (per hour) (includes 1 paramedic and 1 ambulance | $96 |
BLS encounter charge | $100 |
Trip sheet fees | $25 |
C.
Failure to provide or respond to a request for insurance information by the City shall result in an additional $50 fee applied to the balance owed.
D.
Failure to reimburse the City, as a result of an insurance provider paying the patient directly for EMS services rendered, shall result in an additional $50 fee if reimbursement has not been received in 60 days.
[Amended 12-2011 by Ord. No. 14951]
This regulation is effective January 1, 2012.