Quoted from bumblethru

Hopefully the town attoney(s) will be able to read and explain these bids to the town board. It will be long after 4/13 before this is resolved.
And I'm sure everyone agrees that this stuff should have been taken care of l-o-n-g before now.

Quoted from Yossi

Mohawk takes too long to get somewhere.

Quoted from senders

add them to the firehouses....let them be managed there....you want a ride with government $$ ---- HAVE AT IT

Quoted from TippyCanoe

so now it is not a bid

it is now a Request for Proposals

and the results will not be read aloud and there will be an executive session to make a final decision -

I see the Democrat Whore - Crystal Clear - has installed her dancing pole in the main meeting room at town hall

Quoted from gadfly

The FDs don't want them moving in with them...that's why they have been among the strongest supporters of a publicly
funded REMS....they don't want REMS cutting into their tax revenue...they wanted REMS to secure their own tax bonanza.

Now that the tax scheme has failed, they are lined up behind head cheerleader TJ Hooker in trying to secure the next best
thing...a steady stream of guaranteed business through the ems contract  discussions currently in progress...nevermind their
demonstrated inability to manage a business or the loads of cash they inappropriately withheld from the Town all these years.

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State law does not allow towns to provide their residents with fire protection as a municipal function. Instead, fire protection is provided either by a fire district or through creation of a fire protection district.
There are about 1,850 fire suppression or prevention organizations and over 114,000 firefighters in the state, including over 96,000 volunteer firefighters.
The fire district system was established in the 1932, by the State Legislature as a means of insuring adequate fire protection throughout the state. Some 800 fire districts were established, primarily around the existing volunteer companies, which were originally established to protect rural villages with horse drawn apparatus.
Robert H. Fickies, Commissioner, Averill Park & Sand Lake Fire District No. 2

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How is fire protection financed?
In cities and villages, general municipal tax levies support fire protection. In areas of the town served by fire protection districts, the town levies property tax.
A fire district has the power both to incur indebtedness and to require the levy of taxes. Fire district taxes are assessed against the taxable properties within the district and levied and collected at the same time and in the same manner as town taxes. Towns collect fire district taxes and distribute them to fire districts. These funds may be used to purchase buildings, equipment, and insurance, as well as pay for firefighter training. They may also pay for annual inspection dinners and refreshments served after meetings and emergencies.
Fire districts get over 90% of their revenue from property taxes. Total revenues raised by fire districts have increased 61% from 1995 to 2005, with an average annual increase of 4.9 percent, as reported in the Financial Report on Fire Districts.
In addition to funds raised through taxes, there are two other main sources of funding. The first is funds that are donated to a fire department, such as through coin drops or other charitable fund-raising activities or paid in exchange for facility rentals or special services. The second source is a tax on certain fire insurance policies written by out-of-state insurance companies. Foreign insurance companies contribute two percent of the fire premiums

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written on property located in the state to be distributed to the fire departments and fire districts statewide. Fire insurance money - $43 million in 2007 - must be used for the benefit of the fire department and its fire companies, as determined by the members. For example, fire insurance funds may be used to purchase dress uniforms, turn out gear, and office equipment; and to pay for installation banquets and holiday parties. However, those funds may not be used to fund a length of service award program, and members may not be compelled to use these monies to defray ordinary operating expenses of the fire department. (A portion of the tax is also used for the support and maintenance of the firemen's home at Hudson, New York.)
Other sources of funding include federal assistance, state grants, county subsidies, and tax-exempt bonds.

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Does the town board have approval over a fire district budget?
No. Fire district budgets are determined by boards of commissioners, and inserted, unchanged, into town budgets. Fire districts prepare a proposed budget and discuss it at a public hearing on the third Tuesday in October. Notice requirements include publishing notice of the hearing in the newspaper and posting notice on the town sign board and district website, if one exists. The budget is submitted to the town on or before November 20 each year.
Are there any limits on how much a fire district may spend?
Yes, under State law fire districts are subject to a spending limit. The spending limit is $2,000 for the first $1 million of assessed valuation within the district, and $1,000 for each additional $1 million of assessed valuation. Some expenditures excluded from the cap, such as premiums required to cover firefighters injured in the line of duty; salaries of paid firefighters who supplement volunteer forces; service award program contributions; and most forms of debt service. The State Comptroller’s office is not aware of any districts at or near their limit.

Quoted from senders

they dont 'cut into' anything......The fire depts are handled on their own and are not outside the realm of first responders and REMS
or whatever the name isn't outside of being included with the FD's.....I looked it up and it is more feasible than not....regardless of
the FD's opinion.....are they 'closed clubs'????? honestly it's NOT about ownership territory when it comes to FD's....it's a natural fit for
ambulance to be part of FD's....like Cinderella's glass slipper......the only problem are the wicked step mother and sisters.......

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How to avoid common ambulance billing pitfalls
Sep 1, 2000 12:00 PM

Peter Lawrence

Each year, millions of ambulance trips are billed to Medicare and other health insurance organizations by fire departments across the country. While specialized employees might process the ems claims in larger departments, a clerk may process ems claims as an ancillary duty in smaller organizations.

However, regardless of the size of the organization, the requirements for all departments are the same: You must bill in strict accordance with the myriad complex requirements from various agencies, most notably Medicare. Failure to process your ems claims in accordance with these regulations leaves your department open to charges of fraud, payment of significant penalties and reimbursement of collected monies.

Health care is currently the largest expenditure in the federal budget. The sheer number of claims processed each year by a vast array of providers makes the health-care field ripe for fraud. Current estimates have placed the annual cost of health-care fraud to the U.S. government alone at more than $100 billion. Given both the sheer size of the total health-care expenditure and the extreme estimates of fraud, the government has stepped up its fraud investigations of providers of all types.

In mid-May, the Justice Department announced that hospital giant Columbia/HCA had agreed to pay a record $745 million fine for systematically defrauding the Medicare program over a several-year period. While it's unlikely that a fire department or private ambulance provider would ever be faced with such a significant penalty, it clearly shows that the government is serious about investigating and eliminating fraud.

In most cases involving Medicare or insurance fraud charges filed against a fire department, the problem is traced mainly to errors in the billing process. What departments often fail to realize is that honest mistakes and ignorance of current regulations don't provide a valid defense against prosecution.

Therefore, to protect against possible fraud investigations, fire department managers need to understand the current regulations, as well as the common errors that are encountered when billing for ambulance transport services. The most common errors come from:

fee schedules,

coding and

internal procedures.

Fee schedule errors. These relate to problems with the structure or adoption of the ambulance fee schedule. The most common fee schedule errors made by fire departments are in adoption, choosing a billing method and billing for inappropriate charges.

In nearly all fire departments, every fee schedule or charge must be formally adopted by the governing body, whether it's the board of directors of a fire district or the city council of a municipal department. However, in many areas of the country the local ems agency or county government handles the establishment of the ambulance fee schedule.

While there's nothing wrong with this regional approach, if the governing body of the fire department doesn't formally adopt the ems agency or county fee schedule, then it wouldn't be in compliance with their own charter or requirements. In the event that a patient challenges the validity of an ambulance bill, the fact that the fee schedule wasn't formally adopted could cause the bill to be nullified and the charges refunded.

Billing methods are another problem. Medicare carriers currently require each provider to bill for services using only one of four methods. If your fee schedule is fully itemized and you're limited by your carrier, or if you chose at one time to bill by the method that allows only a base rate and mileage, then you can't bill for disposable supplies, medications or other itemized charges.

Unless your base rate was established with the expectation that the itemized charges were bundled into it, then you won't be able to maximize your reimbursement from Medicare. If you bill for itemized supplies in spite of your previous choice or carrier direction, you most likely will be charged with violating Medicare regulations. If you have any doubt as to which method you're supposed to be using, you need to call your Medicare carrier before you propose any changes to your fee schedule.

This leads us to inappropriate charges. Medicare regulations require that all ambulance providers bundle routine and reusable supplies into the base rate. Items such as backboards, linens and disposable gloves are all considered by Medicare to be part of the base rate charge. If your department charges a separate fee for these services, you are violating Medicare regulations.

Additionally, in 1995 Medicare eliminated the once-common practice of a separate reimbursement for responses after 7 p.m., bundling payment for these services into the base rate. Once the change became effective, any department continuing to bill Medicare patients for a separate night charge would be in violation of regulations.

Coding errors. Medicare and the private insurance companies reimburse for ambulance transportation services only when the transport is determined to be "medically necessary." The Medicare Carrier Manual states that "medical necessity is established when the patient's condition, at the time of transport, is such that the use of any other method of transportation is contraindicated."

In an effort to automate the billing process and make it easier for them to determine the medical necessity of the ambulance transport, nearly every Medicare carrier now requires that all claims be submitted with one or more of the diagnosis codes found in the International Classification of Disease manual. Carriers and insurance companies use these standardized codes to filter their ambulance claims into those that are obviously medically necessary, such as cardiac arrest; those that require additional documentation or review, such as syncope or falls; and those that are obviously not medically necessary.

Since the icd codes were developed primarily as final diagnosis codes for use by physicians, their use in coding ambulance transports is a complex process at best and, in the worst-case scenario, an easy way for a department to commit fraud.

Unless the billing staff is adequately trained to interpret the run sheets and choose the proper code(s), it's quite possible for transports to be innocently coded to identify that the patient's condition was far worse than it actually was. In other instances, the billing staff may be using codes that are too vague - most often only three digits in length - to justify the transport.

Both of these examples will cost a fire department a lot of money in the long run, one by having to pay fines and forfeit reimbursements and the other by losing out on collecting for transports that were truly necessary. It's important to remember that coding problems are the main reason many fraud investigations are initiated. Additionally, it's a routine practice for Medicare and insurance auditors to look for trends or exaggerations in coding whenever they embark on any agency review.

The best way to avoid coding errors is to educate both your billing staff and your field personnel. Billing staff need to have enough knowledge of medical terminology and direction from management on how to handle questionable or vague run reports. Field personnel need to understand that their documentation is the basis for getting the claim paid or denied. If the documentation is inadequate to support the use of the proper code or too vague to allow for accurate coding by the billing staff, the door to coding problems is opened.

Procedural errors. These are the most common type of error encountered by fire departments. They're caused primarily by a lack of familiarity with the applicable Medicare and insurance regulations regarding ambulance transport services. Unfortunately, Medicare doesn't consider ignorance of the regulations to be an appropriate defense.

In fact, the agency considers publication of information in the carrier billing manuals, newsletters and the Federal Register as satisfactory notice of appropriate charges and billing procedures. Therefore, it's important for each department that bills for ambulance service to have an up-to-date copy of its carrier's manuals and to carefully review the appropriate sections of the carrier's regular newsletter.

The lack of a signature authorization form is probably the most common procedural error made by fire departments. Medicare and private insurance companies both require that the beneficiary provides written authorization to the ambulance provider before a bill can be submitted for payment.

If a fire department submits its claims directly to Medicare and insurance companies, the signature authorization line on the hcfa 1500 and 1491 claim forms must be either signed by the beneficiary or printed with the statement "signature on file." If a department fails to receive the signature authorization but continues to bill as if authorization was received, then this clearly would be considered Medicare or insurance fraud - and most likely mail fraud as well.

If a fire department fails to produce an individual signature authorization form after being asked for one by a Medicare carrier or insurance company, then any monies received for that claim will most likely have to be refunded.

However, if a Medicare carrier audits a fire department and finds that these forms are routinely not obtained, the carrier will most likely forward a request to the Office of Inspector General for further investigation. Medicare also has the authority to request repayment of any monies received for each and every Medicare transport for a period up to and including three years prior to the investigation.

When authorization hasn't been obtained, departments often say that the patient was in no condition to sign an authorization form or that it's poor public relations to discuss financial arrangements with a patient who's just arrived at the hospital. While there may be circumstances where the first reason is true, there's never an appropriate excuse for the willful violation of Medicare regulations.

Several methods exist to obtain the required signature authorization. For example, your transport personnel can try to obtain it from the patient or guardian on delivery to the hospital. Another method is to enclose an authorization form with the initial statement, directly billing Medicare or the insurance company only after it has been returned. A more novel approach is to see if your local hospital would add your department to the release/authorization forms that are signed before the patient is released.

The second most common procedural error is the routine billing for itemized supplies or services. Medicare regulations are very specific in stating that only services or supplies actually provided to the beneficiary are covered. If your department routinely bills all patients for disposable supplies, oxygen or other charges, regardless of whether they were provided, then you're in clear violation of these regulations.

There have been several instances where fire departments and private ambulance providers have been audited for their near-constant charging of certain itemized supplies. The most notable case was when New York City ems was investigated by Medicare and forced to pay a multimillion-dollar fine for, in part, the routine charging of supplies and services to almost every patient.

Another procedural problem arises from the ability to build default codes or settings into the tables or fields of most software programs. While these defaults save considerable keystrokes and time, departments need to be cautious about their use in billing for ambulance transport services.

Medicare regulations require that a set series of questions be answered about each transport. Called an Ambulance Certification Record, these questions cover topics such as type of transport, whether restraints were used, and whether the patient was unconscious or in shock at the time of transport.

Because most of the questions can be answered yes or no, many departments set their default to the most common answer. While this may be a good form of fraud prevention if "no" is chosen as the most common answer, that can also lead to a denial of payment for valid ambulance claims if the field isn't checked appropriately.

The opposite end of the spectrum is encountered when "yes" is chosen as the default answer. Wrongly answering yes will lead to charges of fraud and misrepresentation if the patient's condition doesn't support the claim. Since it's possible to harm your revenue and program with either answer, fire department managers need to take a hard look at whether they want to use default answers at all.

Altogether, ambulance billing is probably the most complex reimbursement program in the modern fire department. With continuous changes in the already voluminous Medicare regulations looming in 2001 and health-care fraud a hot topic in government circles, chiefs need to continuously monitor their billing for compliance and accuracy.

However, with a basic understanding of Medicare regulations and a regular review of the common problem areas, most fire departments will never face a Medicare audit or charges of fraud.

Quoted Text

§   304.   Local   boards   of   health;  town  boards;  jurisdiction;
  appropriations.  A town board of health shall not have jurisdiction over
  any city or incorporated village or part of such city or village in such
  town unless otherwise provided by law. Appropriations for a  town  board
  of health in a town in which there are one or more incorporated villages
  shall  be  a  charge  upon the taxable property of that part of the town
  outside of any incorporated village and shall be  assessed,  levied  and
  collected  therefrom  in the same manner as other town charges levied on
  property outside of incorporated villages.

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§  301.  Local  boards  of health; certain cities; appointment.  1. In
  cities under fifty thousand population according to the  latest  federal
  or state census or enumeration, the board of health shall consist of the
  mayor of the city who shall be its president, and six other persons, one
  of  whom  shall  be  a competent physician who shall be appointed by the
  common council, upon the nomination of the mayor, and shall hold  office
  for three years.
    2.  Appointments  of  members  of  such  boards shall be made for such
  shorter terms as at any time may be necessary, in order that  the  terms
  of two appointed members shall expire annually.