Item G05BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: November 20
,2013 Division: Emergency 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 15 accounts receivable for
FY 2013 totaling $114,799.77 for Monroe County residents who qualified for the Trauma Star Air Ambulance
Fee Waiver Program.
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: Approval.
TOTAL COST: N/A INDIRECT COST: - BUDGETED:
DIFFERENTIAL OF LOCAL PREFERENCE: N/A
COST TO COUNTY: N/A SOURCE OF FUNDS: N/A
REVENUE PRODUCING: Yes No AMOUNT PER MONTH Year
APPROVED BY: County Atty C11 B/P Risk Man age rnent . j
DOCUMENTATION: Included X Not Required _
DISPOSITION: AGENDA ITEM #
Emergency Services
RESOLUTION NO. -2013
WHEREAS, Monroe County Fire Rescue Services provides trauma air ambulance service; and
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 interfiscility flights for qualifying Monroe
County residents for flights that occurred after November, 4 2008; and
11 11 ��illillilill lii I liiiiiii
9107MMM11i 11 ligi 101
WHEREAS, the Board of County Commissioners of Monroe County contracts with Advanced Data Processing,
Inc. (ADPI) 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
(SEAL)
ATTEST: AMY HEAVILIN, CLERK
ma
COUNTY, FL
M
Mayor / Chairperson
Mayor, George Neugent
Mayor Pro Tem, Heather Carruthers
Commissioner Danny Kolhage
Commissioner Sylvia Murphy
Exhibit A
Monroe County Fire Rescue
Trauma Star Resident Fee Waiver FY 2013 Account Receivables Write Off
1
Insurance
Amount
Pending
Contractual
Account#
Date of
Waiver when
Amount
Paid
Adjustment
Final
Balance to
Incident
originally received
byinsurance
(Medicare/
Write-Off
Medicaid or
their H a
1
9083214
12/19111
$
12,860.00
$
KOO
$
$
12,810.00
2
9739807
03/10/12
$
10,220.00
.$
1,732.80
$
$
8,48710
3
10239955
03/27112
$
16,140,00
$
14,140.00
$
$
2,000.00
4
10436624
04/04/12
$
15,180.00
$
11,385.00
$ 1,427.00
$
2,368.00
5
10371147
04110/12
$
12,140.00
$
__
$ -
$
12,140.00
6
11319006
07/11112
$
14,700.00
$
4,585.71
$
$
10,1 14.29
7
11641502
07/31/12
$
10,380.00
$
-
$
$
10,380.00
8
12101589
09/07/12
$
9,420.00
$
9,370.02
$
$
49.98
9
12604094
10/31112
$
15,740.00
$
$
$
15,740.00
10
12684490
11/08/12
$
11,340.00
$
$
$
11,340.00
11
14241198
12/10/12
$
12,780.00
$
6,412.00
$
$
6,368.00
12
14389385
12/22/12
$
9,340,00
$
5,036.00
$
$
4,304.00
13
14821013
01/09/13
$
10,700.00
$
1,664.00
$
$
9,036.00
14
14262260
01/17/13
$
13,340.00
$
4,903.80
$
$
8,431 .20
15
15469117
04/18/13
$
15,660.00
$
14,428.90
$
$
1,231.10
Resident Fee Waiver Totals
$ 189,940.00
$73,713423
$1,427.00
$
114,799.77
1