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ORANGE COUNTY <br />BOARD OF COMMISSIONERS <br />ACTION AGENDA ITEM ABSTRACT <br />Meeting Date: August 18, 2009 <br />Action Agenda <br />Item No. <br />SUBJECT: Approval of Proposed Emer ency Medical Charge Review Process <br />DEPARTMENT: Emergency Services, Revenue PUBLIC HEARING: (Y/N) No <br />ATTACHMENT(S): <br />Proposed Emergency Medical Charge <br />Review Process <br />INFORMATION CONTACT: <br />Frank Montes de Oca, 245-6100 <br />Kim Woodward, 245-6100 <br />Jo Roberson, 245-2727 <br />PURPOSE: To present for adoption a proposed appeals process for a concerned resident to <br />dispute a charge for emergency medical services rendered. <br />BACKGROUND: From time to time since Orange County began charging for Emergency <br />Services in November 1996 instances have occurred when medical charges are questioned due <br />to billing errors, patient care complaints, and mistaken identity. These concerns are addressed <br />quickly by staff and are typically resolved. Infrequently, there are cases where careful review by <br />staff leads to the recommendation that the charge for emergency medical services rendered to <br />the patient be either reduced or voided. Since 2000 there have been only four reviews that <br />resulted in bills being waived. In 2008 several transports occurred causing the Revenue <br />Department Director and Emergency Services Department Director to review them for <br />correctness and appropriateness. This was an anomaly and the procedure causing these <br />billings has been corrected. <br />Currently only the Board has the authority to reduce or abolish emergency medical charges. <br />However, it would be a breach of patient confidentiality under Health Insurance Portability and <br />Accountability Act (HIPAA) if the emergency medical documentation required for a <br />determination were to be presented in a public meeting for Board action. HIPAA and state laws <br />do not necessarily preclude sharing of patient information among and between EMS providers <br />and other health care providers, law enforcement, regional and state quality assurance systems, <br />and other users of public health data. However, in the exchange of such information, EMS <br />providers and systems are to be vigilant in ensuring the protection of data for the purpose it is <br />being released. The sharing of protected information should be kept at a minimum ensuring <br />that anyone with access has received the training required to access private health information. <br />Staff in consultation with the County Attorney's Office has developed an appeals proposal that <br />would provide for timely, objective review and resolution of patient concerns by the appropriate <br />County officials in compliance with HIPAA regulations. Under the proposed process, the County <br />Manager, or designee, would be delegated authority by the Board to receive the review and <br />