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Delaware County EMS seeks direction to adopt ‘insurance-only’ billing, to refund inadvertent patient payments
Summary
County EMS directors told commissioners the department meets federal safe-harbor criteria for insurance-only billing and asked for direction to formalize policy; staff said billing was paused, refunds will be issued to patients who paid deductibles and the county will return with a formal resolution.
Delaware County Emergency Medical Services on Feb. 24 told the Board of Commissioners the county meets the federal Safe Harbor criteria allowing the department to adopt ‘‘insurance-only billing’’ for all transported patients and asked the board to direct staff to draft a formal policy or resolution.
Jeff Fischel, director of Delaware County EMS, told the board that after a change of billing vendors the county reviewed state and federal rules, worked with outside counsel and the vendor QuickMed Claims, and concluded the county ‘‘absolutely meets all the requirements of the Safe Harbor Act, to do what we should be referring to as insurance only billing.'' He described insurance-only billing as billing the patient’s insurer so the individual does not receive a bill.
Fischel said the department paused outbound billing during the vendor transition and will instruct the vendor to resume billing under the clarified approach. He also told commissioners that a small number of patients had inadvertently paid co-pays or deductibles; the vendor will be instructed to refund those payments. The director asked the board for direction to prepare a formal policy or resolution and return for a vote.
General counsel Eric Hostetler confirmed the county’s review of the safe-harbor protections and said revisions to the written policy will explicitly reference the Anti-Kickback Statute safe-harbor language to ensure compliance with Medicare and Medicaid rules. Hostetler said the county’s intent from the beginning was to bill insurance and prevent patients from receiving collection actions.
Commissioner Gary Merrill said the shift to insurance-only billing was the original intent when the county began EMS billing and expressed support for formalizing that approach. Fischel and county counsel also discussed residency scope; staff recommended the waiver/insurance-only approach apply to all patients regardless of residency to avoid confusing distinctions for visitors and short-term nonresidents.
Fischel described operational details staff will clarify in the formal policy: the vendor may send two types of mailings — an insurance verification request and, for Medicare patients only, an Advance Beneficiary Notice (ABN) that may ask for a signature. He noted that ABNs contain no dollar amount, and that the county will ask the billing vendor to improve clarity of mailed forms for elderly recipients.
Because the billing vendor transition generated some returned or unclear Medicare signatures, Fischel said QuickMed Claims will request signature clarifications in some cases so Medicare claims can be submitted. He said the county had paused billing during policy review and will resume only after providing the vendor with clear direction, including issuing refunds to patients who have already paid.
No formal vote was taken on Feb. 24; commissioners gave informal direction to prepare a formal written policy and to proceed with refunds for improperly collected co-pays or deductibles. County staff said there is no compliance deadline and that the county is already in compliance while the written policy is finalized.
