A. Pre-Hospital Patient Care Reports (ePCR) The LFD will provide to the awarded Contractor access to the electronic patient care reports (ePCR) information through the current Image Trend ESO emergency management reporting system. Under this contract, the Contractor shall process ePCR information and coordinate invoicing and collections to insurance companies including but not limited to: Medicare, Medicaid, managed care organizations, commercial insurance companies, and other designated third parties and payers for billing rates established by the City. The Contractor shall provide routine billings for EMS transport, follow-up to residents and non-residents (customers), and claim submissions to Medicaid, Medicare, insurance companies, and other designated third parties. The billing and collection services include fees for Basic Life Support – Emergency, Basic Life Support – Non-emergency, Advanced Life Support – Non-emergency, Advanced Life Support – Emergency, Advanced Life Support – Emergency with three or more medications combined with at least one specialized ALS procedure, Treatment - no transport, an oxygen supply charge, and loaded GPS mileage of the transport services provided by the LFD. The Contractor shall prepare and submit claims, bills, invoices, etc. based on the patient care reports or data forwarded to the Contractor by the LFD. Knowledge, experience, and judgment shall be applied to avoid or prevent the submission of claims, bills, or invoices to any third-party payer in error. B. Required Verification and Missing Information Follow-up The Contractor shall notify the Billing Liaison / Billings & Collection within two (2) business days of receipt of the ePCR if any documentation is incomplete or does not qualify for reimbursement. The Contractor shall assure that all the information needed for billing is obtained from the appropriate hospital, if not provided in the ePCR. The Contractor shall provide all labor, materials, and equipment for verification of ePCR customer information. The Contractor shall obtain from the policy holder or responsible party all information and signature(s) necessary to file a claim with Medicare, Medicaid, insurance companies, and other designated third parties. The Contractor shall gather missing customer and insurance information by, but not limited to: searching the insurance provider’s databases for previous customer information if and as permitted, searching the Contractor’s billing database, contacting the receiving medical facility, or by direct customer, family member, or responsible party contact. When contact is made with the appropriate party, the Contractor shall verify and correct all customer information. The Contractor shall attempt to obtain the necessary information with at least one follow-up notice or phone call if the customer information is incomplete. The Contractor shall also work with City hospitals to obtain billing and insurance information for customers that are transported to their facility by the LFD. C. Account Billing and Processing The Contractor shall prepare and mail all invoices and overdue notices. The Contractor shall process all accounts, including the uncollectible and insufficient information categories.
