- Program Available to All Physicians in Ventura County -

Ventura County Medical Association works to bring EMSF Funding to the Highest Levels ever! $893,000 has been paid by the Emergency Medical Services Fund (EMSF) for fiscal year dates of service 7/1/2000 - 6/30/2001. Reimbursement was provided at the highest level allowed by EMSF Regulations (50% of billed charges) for all paid claims.

The Emergency Medical Uncompensated Care Fund allows for a percentage of tobacco tax and traffic fines levied in each County to be earmarked to pay for uncompensated care rendered in emergency rooms, and OB or Pediatric services rendered in-patient and out-patient settings.

Also referred to as the Maddy Fund, EMSF Program or CHIP funding, under the auspice of the Ventura County Health Care Agency new funding sources and administration requirements are now in effect, and as of dates of services rendered July 2000, this program is being administered through American Insurance Administrators of Los Angeles for claims processing, with the education/policy component administered by the VCMA.

The process for claims submission is not complex:

• Claims can be submitted for all uncompensated services provided in hospital emergency room and follow-up care within 60 days of initial ER encounter; or Obstetric and/or Pediatric services provided in ER, hospital or in office settings.
• Claims must be submitted no earlier than 90 days from date of service, nor later than 120 days from the date of initial billing of services; a reasonable effort to collect must have been made.
• Submit services using a HCFA 1500 Claim Form with signature; complete Acknowledgment Form and a Patient Data Requirement Form supplied by VCMA.
• In hospital services: patient must be admitted through hospital Emergency Room, and treatment/procedure must be within 60 days of admission.
• Reimbursement rate is a maximum of 50% of allowable charges (based on fund availability and claims received on a quarterly basis).

2002 Update:

Increased Funding Levels Diversity of funding sources have enabled our local EMS Fund to receive close to $3 million for Fiscal year 7/1/2001 - 6/30/2002, to reimburse physicians in Ventura County for the estimated $5 million in uncompensated care provided in Emergency Room Services and by OBG and Pediatric in office services. This is the highest funding level ever in the history of this fifteen-year-old program.

This includes a $900,000 allocation from the Ventura County Tobacco Settlement Allocation Committee to expand reimbursement to cover uncompensated services to trauma patients for up to 60 days from the initial ER encounter.

Expansion of Eligible Services Effective July 1,2001 eligible services are expanded to include care provided ER patients beyond the current 48 hour threshold, up to 60 days of the initial services rendered in an Emergency Room within Ventura County, regardless of location (in office, hospital in-patient or out-patient) for extended or follow-up care. Date and Provider of the initial emergency Room visit (See section 19(4) of Client Data Form) - to be submitted on a separate claim form.

New Claim and Acknowledgement forms are required. Please make copies for multiple claim submission. One Acknowledgement Form per batch, one Data Claim Form per claim.

Submission of claims is critical to ensure renewal of funding sources for the 2002 - 2003 Fiscal Year. We are in a Use It, or Lose It situation!

VCMA is the contracted Educational and Advisory component of the Ventura County EMSF Program. Call VCMA 805/484-6822 if you require a complete set of Policies & Procedures, or if you have billing, submission or coverage questions.