HomeMy WebLinkAboutAgenda - 09-17-2002 - 8f ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: September 17, 2002
Action Agenda
Item No. -�
SUBJECT: Blue Cross Bice Shield of North Carolina Ambulance Service Contract
DEPARTMENT: Revenue PUBLIC HEARING: (YIN) No
ATTACHMENT(S): INFORMATION CONTACT:
BCBSNC Contract wlexhibil Jo Roberson, ext. 2727
TELEPHONE NUMBERS:
Hillsborough 732-8181
Chapel Hill 9684591
Durham 688-7331
Mebane 330.227.2931
PURPOSE: To approve a contract o allow the direct payment of insurance reimbursements to
Orange County from Blue Cross Blue Shield of North Carolina (BCBSNC)for Emergency
Management ambulance services.
BACKGROUND: Since Orange County began charging for the Emergency Management
ambulance service in November 1996, Insurance claims have been filed on behalf of all clients.
Shortly after Orange County began charging for the Emergency Management ambulance
service,discussions were held with BCBSNC concerning the County's possible participation as
a provider under the company's insurance program. BCBSNC requires a contract agreement
as part of this participation,with providers accepting their designated fee as full payment.
However, at that time,the reimbursement levels proposed by BCBSNC word not have allowed
the County to recoup a reasonable portion of the cost of providing emergency merlical services.
Since that time, BCBSNC has significantly increased the reimbursement rates they are willing to
pay, to the point that the County would receive virtually all of the charges established in the
Countys EMS fee schedule as approved by the BOCC.
BCBSNC is one of the largest insurance providers in this area, with approximately 500 to 600
Orange County ambulance service claims fled annually with BCBSNC as the primary insurer.
Approximately 30%m 35%of those clients receive the insurance raimbursement directly from
BCBSNC, but for various reasons do not forward those funds to the County for the transport
services provided. That results in substantial add itbnal staff effort expended In contacting
these clients and a9em ri ng to recover money that should have been paid to the County.
Under the proposed agreement with BCBSNC, all such payments (including those where
BCBSNC is the secondary insurer, following Medicare as the primary insurer)would come
directly to the County.
This contract will enable Revenue staff to provide better service to citizens by handling the
entire financial transaction associated with their ambulance transport. Direct payment from
x
BCBSNG will increase the amount of revenue the County is able to collect, and will allow
Revenue staff to redirect a portion of their time to other, more productive revenue collection
activities instead of following up on BCBSNC insurance payments.
FINANCIAL IMPACT: The table below reflects the fees charged for various categories of
Orange County emergency medical services and the reimbursements that would be provided by
BCBSNC Under the terms of this agreement:
SERVICE TYPE ORANGE COUNTY FEE BCBSNC REIMBURSEMENT
Basic Ufa Support $250 Allow 100% Relmbusement of
Non-Emergemy Choose
Basic Life Support $300 Allow 100% Reimbursement of
Emergency Cha e
Advanced Life Support 5600 Allow 100% Reimbursement of
Entromenor Chance
Advanced Ufa Support $450 Allow 100% Reimbursement of
Emergency Change
extensive support required)
Advanced Life Support $1001$150 $22.88
Non-transport
Mileage Reimbursement- $5.00 $2.57
Per Loaded Mile
Most common servire stye
Approval of this contract will allow the County to streamline the collection of insurance
reimbursements involving clients covered by BCBSNC. The reimbursement rates from
BCBSNC will allow for full recouping of County charges with the exception of the mileage and
non-transports. EMS Administrative staff are pursuing discussions with BCBSNC to explain
Orange Cou nty'a award winning first responder program and to try to negotiate higher
reimbursement rates for cases where the paramedic assesses and treats patients on the scene,
but releases them without transport. There era comparatively few of such rases annually so
the amount of revenue the County will forgo on that category of service is minimal.
Nonetheless, EMS administrative staff are working to convince BCBSNC that it makes greater
financial sense for all partles tc treat and release certain patients for the $100 or$150 fee
rather than transporting them by ambulance unnecessarily at a fee of up to 5450.
RECOMMENOATION(Sj: The Manager recommends that the Boom approve the contract with
BCBSNC and authorize the County Manager to sign k, subject to final review by staff and the
County .Attomey.
4dB rt
TBLSAN UL4YCJS SERVICES AGREEWAT(Ihe"Agreemmf)Is entered mw epomt,,
as of tM Efieeuvc Date set(oM Mrwlks w Nu Ageeman d by snit belwcm Bose come Set doe ShicU
a Nwh parodied m fndep=edem Ilrasw of the Btu=Core and Bids smela AaaoeL6o,and
smWlenw strikes pmridn.('Pmvld&),BeseaPerordered!m colleatiwly as iha y,mus"p
WHEREAS BCBSIVC to a hospital,move r al and deuml service corporatist Ivuosed by me Smu
afNwth Caroline uedtor by sea mhnjwMicliens is raw So regebM by law wrcgulemn to meet doe
Wligatiays set foMm dug Agtasrnt and
wBN;di RoNder is a Provider of ambelies In was and or duly Retried,regiamed,
wm5,d,or Interweave oulamisty u required by low and manlatim,to Imm ids amteleuce aavicce in each
amad sine in which mch sessions are b be pronddl under this AgrccmenS SOd
�REAS doe Patties m this Asteemem sl to facilitate the o6tienl=ndwveHi Oe
denvery of gwsty emboluo a me,,ldIll,so,errd under health Ism fit plan rothmwuo
mlitled to provider emwmk services made avahable m othervitt ad=,,stood by BCBSNC;
NOW THEREFORE the petiea in cousWet mn orthc mnmel coveomtt and statements set
fetch herein,do b= my same ulallowa:
L GENERAL OEpINITIONS.
LI BCBSNC"meeoe,azapp4coblc,ey anewmwe oftM folbwing: O fflue Ctmsawl
BlmdiieWafNaMCmotlm; Bd PmovalU VIanofNmth6wm ,mo(,P NC$ (indmy
DCSSNCpvm4 aobeidiC; moor iI) of➢C➢r Mss CmPCP-NC shied plan mpmrp es if
BC83NCsud/or PCFNRuudtm (Iv)avyoS¢r Blae Owe and Blue Shield plmffirpwpreee afihe Blue
Cutl pmgamso[her progmmcoordinated WIWBCBSNC.
1.3 °Group"means my parry That Bass emercd mu,I moment fir Mnith does Indoor warrants
ompmaanw m"respe Motion de Mmieuvati®oftrocfc t,Indoor the pmvuteo ofpovider tremmk
wirvicub to"I'tae ldembem wJh my of the mffmvwg'. (]ECB9NG (u)mutter Blue(fross aedborRan
Sti=W plan of mrymwc prcoy mbml my or affiliate thereof,®d/m bat) ,,mdr nealth plan whuh be a
reciproaty
or INher agreement and,BCBSNC
I3 "Nlesxl ^meml an mmintlml deogmted by a Group or by BCBSNC an thews=may
be,b be engthlc for health benefit Plan coverage sudden bmefNS mi or provider network ad vita under
BCBSNC'e wunac6 wile Gwups.
S. PROVNERb SERVICES ANB OBLIGATFOrtS
provide agrees as provide the corvine and cemy om the obligations ant better do folloar:
3.1 Memlw Cervle+n Ytwideragssmpmvid a ambuLnce eerviceafor We travapanof
Membet9lnutwdmwwit4'. (IJ all vppticabk lucvl,adm and lNmlhwa mdregWOdatu; (a)awR4H
ledwhy nmdndq and (fip me terms and mvNHws set fMh k[Ws Agmmoi
22 V,bivla.EOwrommtmd SOOONa hovidnagteen du[Jl vehicles.equipment.
supp4es m oWergmdaosedby Pmside=innmyiog uui Aovida'asmicn avdobligado^s wMNu
agmmmi thallh: C)Propetl9 amviced andmuotaom; lNJ titlW.licensed,wawed,bmdeq reglsterM,
etti!=d,or omerwiee euthowd Marcgwodby wchjurcdictiaemwnmM1 ewicm aapmsideduuda Wv
Agrcemmt,m provih amhlmce servmeu m Members.
d
13 Pena pt6 l'mvidesngemt6aeillemPloyweav3lm ivdepmdutteevhectorc oroNm
pommel dealgoetN by pmvidm to assist an cmtywg out Pmvidci a&ties end Itigatiovs under this
Agreement shall his: (i)satiified m Petfmm thcar desig^^kd NOCeons;(u)Hessaed,mtifed,"Isisubsed,
oc oWetwio,enami,od as eeyuiredbyeach l'^istlielm in^hish wn'icm ate peovided Insist this
Annotation he peRmm then chug and emotions,and (,i)covered by IiabiliN WSUtavice ofNw type and in
tye amounts"Capable to BfYSNC.
Sq p l4 Pasiment and Holies Pmvoles agrees Wit Wiling and payment by HC13SNC
fm smvices to Meatiness shall be as set froth m 9WMt 9.4 by this Agaemm,wkch is h,Nhy
ummPmatetlbYrefertvice ivw tnc u�ms of thu Agtecmvmt Pmvida PoMaagrccs tlut mchpoymmt
challes, WSChuge BCBSNC,ed Memsolsli and stations' usethii41yfm ROVidw'a
charges,incWJing,bW mMI irod w, ue,sock mdamkni mv¢wsatiogmdthrt PmvWCrelnll has
wtlenmry cNCVrmben bill mmnemae uekpaymeW Goat BCBSNG tMember at orry thiMpvryfm
hovideiasw loss rebove,Use Provider maetlmie to mforN1)mdpplkeb'compmble
or consensus,;co
the above,thepmmdmmaybiOthsMmibm for.(1) e]iro,llWbkes shevM15
bar=m add,soish, no mQt)my oovcovwd awiwfmwAChlbc NOVldervicea she Memb¢nodm
hfine rtadew Neearviu vione jxyr p, ,lth that Nre make s th i,in that son smvtamay not be covered thon
bYBCBSNCOsatya appndedshutshe,and bu agree invmbo Iben the Membv ce be ndoneed to a for
pay&ai:andn payment fun shut she Memhv agrees wwsit'mg rtmesmite utmdmei mine
ms�mWkfrt WYatmtoleuch non-vovuatl Canes.
E.5 HCBSNCAndltandlnmeli it. Pmvidera a tbet BCBSNCahallhavethe NghS
Upon"I"It,by audio,inspect,medc^f atr+%wwble names and at an WNUotW charge,ssi
Mcemrnb,accountins,show wirative and medval temi and any and all other types Ofrewds
pcnaiNng 0 o sUretl no We petfwmeam and edmmusehov of the.wmms mad obligations set fuM in
thisAgeemmt PmviderfuMcx agrees tho[BCHSNC has thetipy to Use whalcvv eWitmeehodologyY
dektmwee approptinle. BCBSNC'stighls a&I mlh in Was Seetiov E.S ehallivtvivecesmwationnfttis
Ayeemat[
E.fi idCUNCIndessiond a nNOn. ITwitlet aahmwledgca ita
uMenmdmg Wen NilsAgeemm o Iimtw flaoatncl6ehvicenlheliUVidn and BCBSNC thn
HCHS V C is an indepahnt empmatiw oPmhvg U^tlm a liceme&oat du Blue Ltou Cad Blue Sbicld
AeawunogCBSNCWtiw thiodependent Blue IXaea and BWessues Plw(theStati OfNorba
pes®(eiag BCHSNC m Uec the Blve Qose avNur Blm Shield service Uah m Nte Smte oP North CaW w,
snd dun BCRSNCisvatsIn¢acting ee[M1e egret ofMe Aaseuetioa. NovidecfinfhC'sckmwleiga and
'gegreawnieatio,mafiner rWa tham a IJCe SanNm C Om that no fai bu unW^m upre[enatiw on Othrenoyp mBmCB4 S®NC NN about held so h ba b Ne P,,idv for my of BMSPC'a obligations to Provides not Russia in tm ie
s,
BmyyC am.hThw iJston same bliption;von hand,uidevW other post tigeiaatinwe.signs uon the pertof
Agtemimt
2.7 If Provldts agtem m mmpls
wub,and sNWe by the dwimms of,all Ippfuable BC11914Cpsograme,litigation land Pmmdures u maybe
enacrcdmdrtviaed Flom date m
amplmvro wiJS LereyUVemcanu v of any"a Mudtes®egrem,upovmaryuaIsnr,lm c n pm®ulmincWetlSww es o.f
3. BCBSNC'S OBLIGATIONS
BCBSNC agrees oughts he pmfmm,or to have Podwmn]by m authorized repreentmtivN'geW,
the following obligation,
3.1 Mme Naaide admivisbetive,eaaaandng,dembuemvagemea4
terming and other Poncnore vaewryw Weadministnnoan wdpssfonmaoce ofimabligetma cadet Wier
ggncemm[ '
5
3.E Peuca ncCe iomekere sable eflmis mpmec ¢claims fm sw rentluetl
by Pmvitler b Members wi[M1in[M1vIY(30)dap of BLbSNCt m'eipt[fall iNOrva[ion naceeary m
psrcess emholamu,
3J Yavmmt FOr Servie¢ is paY Providmfm urview remlmed to MaMeta is
dCCmtivse wiO the pmviaiovs ol$e[flov EA and Exhibit EA bfhisAgeemevt
4. 'PERM AND IER ATION.
4.1 ERecdve Oateand Term This AgltemeW shullh tIf"iwas ofthe Et£'vo Date,
whkh,haUbethe day of ,EO 1 and the tom shall cominac in effect WertaR lore
paiodofone(1)y Dis Agreemead shadaulomabmlly renew for ad&tieml maycsr rms,uNess
Mmwvhd eeoo¢M1y e i IM1er ryrty as al6vwise monam iu Wia gy.,mrgv[,
Al T¢mmfiaa With or W'thoWCeom Ei1MeECDWCwPmvWwmay LL'uanaoo
Iltie
then vonoyineh(evtpmY t®e,mL oewiManitaus,upaopnmxnPm votivemthe wlm P^nY ofmllove
OO)dvY%
S. NOTICES.
5.1 MAM1ntl of DeGVery Auymt¢bbe givrn wtlo tM1is Age®em[hall be iv wring,
edtlrceeed tothe oNwpmryae We atldeueIinM in 9eeliov 53,wsuch othwadM:ueaveepuryf
devi stem bynwiee b IM;alhceParty,mtl¢hallbe deametl Sivrn oa wpmwv hdana livery,or ce
oagoesuchvati pay delivery widnlhe UuilW SmteaPmdl Service,mmfiNwJ,rtlumreceiPl
[¢gush{pcslage pwTgid.
52 Addy 'lhepmties'�mmnandeddreeanfm puryauaol Biwi6 notice uodmthie
Ageemmt shall be as fellows:
BCBSNC Fravider
6 INDBPEND 7CONTTGCIdN .
Nother pap to tltis ASf a rtheir rtepof6ll employees or agrnp shall be domed to M an
agm5y none,eem be that of lheolhonot auem" ecknnwle3yc and a®ee Phut lM1e nladmwbip
belwernth®¢ball be thatafwtlepevdmt convacmm.
7. ASSTGNMENLSIIBCONT¢ CTING.
7.1 Providm hovidea ahuBmlaeeigy enhuomm,dehpa�q or oWCmee trmefatltis
Agmoomerd an&"any of Provitlela..ices and rbfptua'u one,Agre^JOem,piOOm do
' n[afB®SNC The pamw ogee tlut vPOO VrysuchacsigmeW,suhconoact,delegaliwm
Mee on poovlbdyerh.ovitln,BCeSNC¢Fall M1avv 0erightro temwmc IhiaAgmom[imveNelely upw
71 PtR c BCBSNC rhall give pmriduprim wnMV soli¢¢of my weigvmevl,
sukmaast deh:guuw 01'Ahor bo sfe'of this Ageenenl or any ofeaD3WC's duties or oblipbone
under Die Agreement
6
S. EWi AGREEMENTIANDENDSORM.
Thin Agttemmt and Or If Ir in NU Agamml canantue d"I'm m a®eemeN Shared the
panties. No amendment to this AV W sha0 be eRanve unless of wntwg,ar ad by MO paves,with
the e::chwa,get Rod,in tWC Section Ran lollowe:
gel In Oe evem m i L BCBSNC drummers Oxl federal
and/or agar,to% of repeaters requirges Salmagundi Mmes Agean t Ocu BLDgNC Shall give Ptovidn
duty(]0)dr,Morativm malt,,and agent exphxti000f well]6day padN.trine Agreement stall be
autertatically amended to include the ameudmmu xtt food in BCBSNC`s natix.
BS Face,miu,-laoviderrigningeot. Iv thaw wOat BCBSNC de¢ ee Jena chengn In
tbu
four or St cnt are a rgeopnarc,,door Ch shoo ar^'=RoWduwmm�wtiee Oftlees Nan 90 days
gnionm Me eRxtive da¢mmch Jmnga. Ilpw expintlonef such 90 daypewd,OV Chavgeg get fonO to
O(D6NCSmtico eFWl oummetically gales eHed.
9. GOVENNINGLAW.
his Arr""'t'haLL he all watancca and mac,a conormis ,he governed by andwmhued
xmdmce wit Or,laws of the Stns at North Carolina,excluding its choice If law andtm conflicts of
law increase, The patties hereby erneerm and ayem flout the canna for am,legal aztim under m mleting
or this Asrecmmt aball be either Darkness or Omngecount North Camara.
10. T®9 AGREEMENT SIIPERSEBES AU.OTHEBB EETWEEN THE PARTIES.
he pang aeasmvledge and a®a=met this Ancestor eupmmm MY and aB Off or aEtennema
harem We Not regarding me avve of similar aervUre,and that all acct oOvagevwmu tetwsn Na
part are renderetl nWI war void as Of the Emerge Oat:gn Sabo above in Nr cantonment
LN WffNESS WHEREOF,tech four to Ou Ageement ho s mua 1me dud,northeast
hater, sarave to a ps this Agmcmant on as broad below,effective as ofWvEffective Date get Sabo other
wtbir A@emed.
Blow Cross and Blue Shield of provider
North Cautious
By: By:
(Bigulare of Nelanaeutatm,Duly (Sigmture of Regrecertative Duly
Authoaiml is Sign Thu Agrccvrnt) Authm'ixM to SIP This Agrcmtess)
PtlrtRype Nam, Pniotfirshe Name:
Three Title:
v
E%NI82r1
Provide.P.r"'e"t.na anms
A. Amtler PBvment C ngisxd with Section 2A of this A nmmvt,Ptovidv alt sProvider
sM116e paid by BCBSNC as follows'.
A.1 Ilwe I Ualpaii and Reasonable lflCRl Reimbvrsenevt For a ReNtioval and
C P¢bmSlve Major Mafcal(CMM)Plot,and Prc4nN C e(CostW),excepl Blw'Edge e,
dean Ted in Section A2 or this Exhibit 2A,IXBSNC expects b pay and Pmvivo dames to accept a
payment m fall for se dos deLvemd to MemMe,OSOal,Caetnmary a ad Reasonable reimbmumem as
defwd w Jm booklet"ONal,Ll t m,,y and Reasonable,ad BCPlmntlon for Doan¢".
A2 C om. For BIne Edge Plans,BCBSNC agrees to Pay and leroeider agrees to
accepr as payment w WI fir awices deh mdm Me ,",it 1,d],d huge.
12 FIIS Fm e1111ee1th Maimmavw Onaavlvtlw(Em10J,POWto[5¢vlu
(POS)toll Referred Ptowdo,Obtewi dim(PPO)Place,except Preferred Care(CoriWlack BCBSNC
shames m pay end Provider agreed ad accept as peymsnt ma M for amnu'ed dWivwed m Members.the bas"
of Pmvid"'a.dual cbmge to the amowt specified w BCBSNC's fee ecb,d W c.