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3 <br />ORANGE COUNTY BOARD OF COUNTY COMMISSIONERS <br />Hillsborough, North Carolina <br />Emergency Medical Charge Review Process <br />PROPOSED <br />OBJECTIVE: When complaints or concerns arise after EMS care has been <br />rendered and billing conducted, customers should have an appropriate venue for <br />a fair and timely review of charges and records. The review process must be <br />sanctioned and delegated by the Board of County Commissioners since theirs is <br />the only authority to void medical fees, should that be the ultimate outcome, <br />Also, the Health Insurance Portability and Accountability Act (HIPPA), the federal <br />regulation that regulates protected health information, dictates that patient <br />medical records must be handled and reviewed by persons trained in the <br />protection of health information. This document outlines a proposed process for <br />the proper review of medical records and the resolution of a concern on behalf of <br />the Board consistent with protected health information rules. <br />SCOPE: This review process applies to billing for Emergency Medical Services <br />rendered to patients. Emergency Services charges to special events standbys <br />are not included. <br />POLICY /PROCEDURE: <br />Questions related to billing for EMS services rendered typically fall into one of <br />two categories: Billing, filing and insurance concerns, (i.e. a patient's insurance <br />company does not have enough information to process the claim) or medical <br />care complaints (i.e. the patient is concerned the Emergency Services unit failed <br />to provide the appropriate level of service) However some complaints will require <br />investigation in both categories. <br />Billing, Filing, and Insurance Concerns <br />• All concerns about billing, filing, and insurance should be directed to <br />the Revenue Department. <br />