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 |
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