Item G04BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: November 20, 2013, Division: Emergen_cy Services
Bulk Item: Yes X No Department: Fire Rescue
Staff Contact Person: Callahan / Pfiester 289-6088
AGENDA ITEM WORDING: Approval of Resolution authorizing the write-off of 40 accounts receivable for
FY 2012 totaling $336,969.86 for Monroe County residents who qualified for the Trauma Star Air Ambulance
Fee Waiver Program. This write-off was inadvertently executed by the Clerk of the Courts office; the item was
pulled from the September 2012 agenda,
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: Approval.
TOTAL COST: N/A INDIRECT COST:
DIFFERENTIAL OF LOCAL PREFERENCE:
COST TO COUNTY: N/A
BUDGETED: Yes No
Iffm
SOURCE OF FUNDS: N/A
REVENUE PRODUCING: Yes No AMOUNT PER MONTH Year
APPROVED BY: County Arty _V 0MR/Purctasing Risk Management
DOCUMENTATION: Included - X Not Required -
DISPOSITION: AGENDAITEM#
RUN
Emergency Services
WHEREAS, on May 20, 2009 the Board approved Resolution No. 152-2009 adopting a fee waiver policy and
process for trauma star air ambulance billing or trauma scene and critical care interfacility flights for qualifying Monroe
County residents for flights that occurred after November, 4 2008; and
WHEREAS, the attached accounts have applied for the resident waiver; and
WHEREAS, the Board of County Commissioners of Monroe County contracts with Advanced Data Processing,
Inc. (ADPH for trauma air Ambulance Billing and Related Professional Services; and
WHEREAS, a report was provided by Advanced Data Processing, Inc. on these accounts and it was determined
that all third party payments have been received and applied to their accounts, that the balances constituted the amount
remains after all third party payments had been credited to the account; and that residents submitted sufficient
documentation to qualify for the resident trauma air ambulance waiver; and
0
Mayor / Chairperson
M
Mayor, George Neugent
Mayor Pro Tern, Heather Carruthers
Commissioner Danny Kolhage
Exhibit A
Monroe County Fire Rescue
Trauma Star Resident Fee Waiver
Account Receivables for Write Off
Account# I Date of Service I Original Balance
160201 -01
12/6/2006
160070 -01
5/4/2009
160106 -02
6114/2009
160144 -01
7/17/2009
160166 -01
6/9/2009
160203 -02
10/512009
160235 -01
11/1912009
160029 -01
21612010
160234 -01
911212010
160254 -02
101312010
160012 -03
1112/2011
160025 -03
1/2412011
160047 -03
217/2011
160073 -03
2125/2011
160111 -04
3113/2011
160033 -0
3/1412011
160101 -03
3119/2011
160103 -01
3121 /2011
160130 -01
411412011
160144 -02
4/2612011
160172 -02
5117/2011
160173 -02
5/16/2011
160197 -03
6/4/2011
160205 -03
6113/2011
160199 -03
6/17/2011
160225 -02
6/2712011
160237 -03
7/1212011
160239 -01
711212011
160253 -02
712312011
160256 -03
7126/2011
160267 -03
6/1/2011
160269 -03
6/2/2011
160301 -02
9/1/2011
160306 -02
9/1212011
160321 -01
9/2912011
8905906
12/912011
9033215
12/20/2011
9266407
1126/2012
10239949
312312012
6361235
12/612012
Resident Fey
Waiver Totals
$
12,140.00
$
14,300.00
$
14,140.00
$
14,140.00
$
12,060.00
$
9,320.00
$
11 ,740.00
$
15,660.00
12,060.00
$
12,060.00
$
14,220.00
$
14,140.00
$
14,360.00
$
15,420.00
$
13,260.00
$
15,420.00
$
14,620.00
$
15,420.00
$
16,060.00
$
15,420.00
$
12,060.00
$
9,260.00
$
14,700.00
$
12,940.00
$
9,340.00
$
9,420.00
$
9,420.00
$
13,950.00
$
15,420.00
$
15,420.00
$
9,420.00
$
12,140.00
$
16,060.00
$
15,420.00
$
13,930.00
$
9,660.00
$
10,330.00
$
16,060.00
$
16,060.00
$
11,130.00
629,920.00
2,500.00
10, 503.66
$ 3,302.00
$ 13,599.10
$ 3,664.10
$ 13,599.10
$ 13,599.10
$ 6,747.64
$ 200.00
o -
w -
$ 9,220.00
$ 12,27527
$ 13,599.10
$ 3,062.50
Ip -
$ 13,720.00
$ 6,959.39
$ 16,010.00
$ 14,144.90
$192,310.14
Final Balance
To Write-Off
$ 512.24
$ 9,300.00
$ 7,134.00
$ 14,140.00
$ 12,060.00
$ 9,320.00
$ 1 1,740.00
$ 13,160.00
$ 1,556.32
$ 12,060.00
$ 14,220.00
$ 14,140.00
$ 14,360.00
$ 15,420.00
$ 9,955.00
$ 1,520.90
$ 5,955.90
$ 1,820.90
$ 16,060.00
$ 1,520.90
$ 5,312.36
$ 9,060.00
$ 14,700.00
$ 12,940.00
$ 9,340.00
$ 9,420.00
$ 200.00
$ 1 ,704.73
$ 1,320.90
$ 15,420.00
$ 1,337.50
$ 12,140.00
$ 16,060.00
$ 15,420.00
$ 260.00
$ 9,660.00
$ 1,420.11
$ 50.00
$ 1,915.10
$ 11,150.00
$336,969.66