Agenda

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County Administrator's Report 9. 16.

BCC Regular Meeting

Budget & Finance Consent

Meeting Date:	09/24/2020
Issue: Uncollectible Bad Debt Write-Off
From:	Jason Rogers
Department:	Public Safety
CAO Approval:

RECOMMENDATION:

Recommendation Concerning the Uncollectible Bad-Debt Write-Off of Accounts Receivable Recorded in the Emergency Medical Service Fund as Uncollectible Bad Debts - Jason Rogers, Public Safety Department Director

That the Board adopt the Resolution authorizing the write-off of $9,128,254.86 in Accounts Receivable that have been recorded in the Emergency Medical Service Fund of Escambia County and have been determined to be uncollectible bad debts for patient claims dating September 22, 2011 - July, 1, 2020. Of the 17,854 claims, 4,700 are from patients with multiple dates of service.

This Resolution allows an accounting transaction to be recorded and in no way should be construed to be a forgiveness of debt. This Resolution includes write-offs from Emergency Medical Services (EMS) Ambulance Billings for 17,854 claims that have been through all phases of the billing and collection cycles, to include all primary and secondary insurance filing, and private pay processing pre-collection letter(s).

Payer	Number of Claims	Total Write -Off Amount	Description
Medically Needy	1,772	1,107,269.29	Recipients who must pay out of pocket a certain dollar amount before qualifying for Medicaid Insurance
Medicaid QI1/ SLMB	493	82,210.79	Has income that does not exceed 100% of the federal poverty level and do not qualify for any additional benefits therefore resulting in a deductible or coinsurance payment
Self-Pay	15,589	7,938,774.78	No Insurance and/or remaining co-payments
Total	17,854	9,128,254.86

All means of in-house collection have been exhausted and it has been determined that these accounts are truly uncollectible, and any further action on behalf of EMS Billing would be unproductive. The process includes reporting an adverse credit rating that could provide additional leverage for the Collection Agency to attempt collection on these accounts. Each patient has received three invoices prior to receiving their notice of pre-collection letter. Each account will be referred to the secondary collection agency in which the outstanding balance will be listed as an outstanding debt with all three credit reporting agencies.

BACKGROUND:

The chart below shows the allocation of charges across the following categories over the past 12 years:

Transport & Standby Charges - transports, treatment no transport charges, events, and facility charges
Revenue – actual receipts
Contractual Adjustments – difference between fee schedule and the allowable fee schedule for Medicare, Medicaid, VA, Tricare, and any HMO plan
Other Adjustments - bad debt reversals, jail write-offs, hardship applications, etc.
Bad Debt Write-off – as approved by the BCC

The 2019/2020 data is as of August 31, 2020. The Bad Debt Write-Off and Accounts Receivable columns include the allocation based on the approximate $9.7 million requested in this agenda item.

Fiscal Year	Transport & Standby Charges	Revenue	% of Total Charges	Contractual Adjustments	% of Total Changes	Other Adjustments	Total Bad Debt Write Off	% of Total Charges	Accounts Receivable
2007/2008	20,241,031	9,024,324	45%	6,588,981	33%	(216,602)	4,844,328	24%	0
2008/2009	20,100,678	9,252,816	46%	6,365,328	32%	(219,112)	4,701,646	23%	0
2009/2010	20,166,624	9,362,589	46%	6,403,097	32%	(265,072)	4,666,010	23%	0
2010/2011	20,646,220	9,831,671	48%	6,921,001	34%	(216,679)	4,110,227	20%	0
2011/2012	24,081,659	10,333,055	43%	8,721,430	36%	(152,852)	5,180,026	22%	0
2012/2013	25,814,884	11,048,463	43%	9,813,004	38%	(150,434)	5,103,851	20%	0
2013/2014	26,928,706	11,826,072	44%	10,174,297	38%	(160,285)	5,088,622	19%	0
2014/2015	27,509,180	12,009,124	44%	10,261,996	37%	(203,802)	5,441,862	20%	0
2015/2016	27,878,748	11,980,898	43%	10,158,481	36%	(145,973)	5,885,342	21%	0
2016/2017	28,261,787	11,673,491	41%	10,240,433	36%	(212,989)	6,030,525	21%	530,327
2017/2018	30,534,552	12,868,853	42%	10,514,353	34%	(130,422)	5,580,260	19%	1,701,508
2018/2019	31,590,255	13,734,762	43%	10,102,072	32%	(154,730)	6,347,169	20%	1,560,981
2019/2020	29,234,158	15,589,004	53%	10,524,718	36%	(63,658)	1,722,856	6%	1,461,238
Total	332,988,481	148,535,124	45%	116,789,191	35%	(2,292,612)	64,702,724	19%	5,254,054

Note: Prior year accounts receivables may not reflect accounts that are still being paid on.

The proposed bad debt write-off will be allocated to accounts in past years as depicted in the chart below.

Fiscal Year	Proposed Bad Debt Write-Off
2010/2011	$69.20
2014/2015	$964.00
2015/2016	$3,348.64
2016/2017	$15,448.75
2017/2018	$1,238,666.38
2018/2019	$6,146,902.02
2019/2020	$1,722,855.87
Total	$9,128,254.86

To determine if the percentage of bad debt write-offs is comparable to Florida Counties of similar size and call volume, staff contacted other County EMS departments to obtain their bad debt write-off percentages. At an average of approximately 21% bad debt write-off, Escambia County is consistent with Counties listed in the table below. Discussions with staff from these Counties revealed that the write-off patient profiles were quite similar also, e.g., patients who called EMS but were not transported to a hospital, patients without insurance, and patients with limited income.

County	Total Charges	Bad-Debt Write-Off	Percent
Leon	33,403,426	6,291,701	18.9%
St Lucie	21,211,191	4,200,000	19.8%
Lake	26,908,251	6,254,625	23.3%

BUDGETARY IMPACT:

N/A

LEGAL CONSIDERATIONS/SIGN-OFF:

Senior Assistant County Attorney Kristin Hual has reviewed and approved the Resolution as to form and legal sufficiency.

PERSONNEL:

N/A

POLICY/REQUIREMENT FOR BOARD ACTION:

N/A

IMPLEMENTATION/COORDINATION:

N/A

Attachments
Resolution