Thursday, August 24, 2017

Patient Resources

Opthamologist sitting on chair.

Emergency Medical Services Fund (EMSF) 

The Emergency Medical Services Fund (EMSF) is a County program administered by the Orange County Medical Association (OCMA) that provides reimbursement to physicians for uncompensated care provided through a qualified Orange County emergency room.  Any physician that provides care within the first 48-hoursof admission to the emergency room is eligible to bill the program as long as they have submitted a current enrollment and the claim meets the program criteria. 

Program Criterion for Payment Eligibility

  • Provider must have a current enrollment filed with the EMSF program.
  • Electronic enrollment and claims status is available online at https://ochca.amm.cc.
  • Enrollments are required annually, effective July 1 of each year. 
  • Services must be hospital-based emergency services
  • Services rendered following stabilization are not covered.  Stabilization is defined under state law (Health & Safety Code 1317.1(j).) as when, “…in the opinion of the treating provider, the patient’s medical condition is such that, within reasonable medical probability, no material deterioration of the patient’s condition is likely to result from, or occur during, a transfer of the patient…”
  • The physician must take a reasonable effort to collect for his/her services from the patient and other responsible parties.  This requires a minimum of (2) requests for payment and 90 days have passed from the date of first patient billing, without receipt of any payment/denial during that period.  Claims older than one-year from the date of service are not eligible for reimbursement.
  • Payment to the physician from any other source on a particular claim renders it ineligible for payment.  Any revenue received subsequent to payment by the EMSF program requires a refund back to the program of the lesser amount received.

The following services are not payable by the EMSF Program:

  • Prescriptions/Refills
  • Physical Exams
  • Non-emergent pediatric and obstetrical services rendered in the physician’s office, such as well baby exams, immunizations, routine exams and sterilizations. 

Registration for EMSF is required every year. Statutory requirements may be found in Health and Safety Code Sections 1797.98a through 1797.98g.

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