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eAG ed <br />cdtgl09 <br />ORANGE COUNTY <br />BOARD OF COMMISSIONERS <br />ACTION AGENDA ITEM ABSTRACT <br />Meeting Date: August 18, 2009 <br />Action Agen a <br />Item No. <br />SUBJECT: Approval of Proposed Emergency 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 proposed appeals process for a concerned citizen 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 voided. Since 2000 there have been only four reviews that resulted in bills being <br />waived. In 2008 several transports occurred causing the Revenue Department Director and <br />Emergency Services Department Director to review them for correctness and appropriateness. <br />This was an anomaly and the procedure causing these billings has been corrected. <br />Currently only the Board has the authority to abolish emergency medical charges. However, it <br />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 <br />systems, and other users of public health data. However, in the exchange of such information, <br />EMS providers and systems are to be vigilant in ensuring the protection of data for the purpose <br />it is being released. The sharing of protected information should be kept at a minimum <br />ensuring that anyone with access has received the training required to access private health <br />information. <br />Staff in consultation with 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. <br />