2011 006 Ordinance - Laserfiche WebLink

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Pursuant to Section 1(F), Life Force shall post payments it receives for the Ambulance Services and report overpayments to the Client. Client is responsible for timely refund checks according to Payor guidelines. Unless the patient has an outstanding balance, Life Force will prepare a request to the Client to refund the credit balance on overpayment. Client hereby directs Life Force to handle overpayments as follows: (PLEASE INITIAL ONE ELECTION) X Client will issue refunds and provide notice of same along with check numbers to Life Force on a monthly basis. Life Force will invoice the Client for the refund amount, and Life Force will reimburse the refund amount after receiving payment equal to the refund amount from Client. 4. RESPONSIBLE PARTY BILLING TONON-RESIDENTS Whereas the HHS Office of the Inspector General (OIG) Advisory Opinions has opined favorably on "insurance only" billing for Medicare patients where a local government that is an ambulance supplier funds EMS services through local tax revenues or fees and categorically waives out of pocket expenses (such as co-payments and deductibles) for bona fide residents, pursuant to Section 1(C)(4), Client notwithstanding client makes the following election on "insurance only" billing ofNon-Residents: (PLEASE INITIAL ONE ELECTION) Life Force is directed to bill and attempt collections from all patients and responsible parties without regard to residency or place of employment. (MOVE TO QUESTION 5) Ltfe Force is directed to b"' ^~a ^'*°^• "°^*~^^° `insurance onh~" btll Non- _ _ _, _ - Formatted: Underline Residents, as the Village has determined that these collection efforts will not Formatted: strikethrough _ _ influence individuals to seek EMS services from Mayfield Village or pose a fraud ~' Formatted: Underline _~ or abuse on the Medicaid svstent. Life Force shall bill "insurance only" for Medicare beneficiaries located in Client's jurisdiction who substantiate their residency status based on reasonable criteria established by Client ("Residents"). Life Force will bill and attempt collections of applicable co-pays and deductibles from Residents who are not covered by Medicare and Non-Residents unless covered by secondary insurance. PLEASE ATTACH COPY OF ORDINANCE/LEGISLATION. Unless the waiver of a responsible party or Resident financial obligation would result in a Client service not being covered by insurance or a benefit plan, Life Force shall not bill and attempt collections for individuals located in Client's jurisdiction who substantiate their residency status based on reasonable criteria established by Client ("Residents"). Life Force will bill and attempt collections