2009 008 Ordinance - Laserfiche WebLink

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documentation, including all denials and correspondence, to Life Force within five (5) days fi-om the date of Client's receipt. REFUND POLICY 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 n nb r 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 TO 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 makes the following election on "insurance only" billing: (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) i _X Life Force is directed to bill and attempt collections from No?'Resid n.ts. Life Force shall bill "insurance only" for Medicare beneficiaries locat d 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. 22068/513664-1 CUSTOMER NAME: DATE: