Board of Supervisors Agenda and Minutes - Regular Meeting

Oh, no, don't worry. I had told her, too, that I was like, funny, I've been in that conversation already. Now, now, I need to, I mean, if it wasn't, you know, and then you've got my peer's message. I didn't know what was going on. I don't live in here. No, we have a conversation. Well, if you ever change mine, I'll be happy to do it.

Right, I'm sure your inbox is quite full most of the time.

Good morning. I'm going to call to order the Dallas County Board of Supervisors meeting for Tuesday, June 23rd, 2026. I have no changes to the agenda.

Move to approve the agenda.

Second. Is there any discussion? All in favor say aye. Aye. Motion carries. Please join me for the Pledge of Allegiance.

under God, indivisible, with liberty and justice for all.

Is there anyone to speak in open forum? Anyone to speak in open forum this morning? We'll move down to the consent agenda.

Second.

Is there any discussion? All in favor say aye.

Aye.

Aye. Motion carries. Item six, the supervisor's minutes from 6-16-26.

Move approval. Second.

Is there any discussion? All in favor say aye.

Aye.

Aye. Motion carries. Payroll change notices.

Good morning. First, we have a promotion in our attorney's office. Then we have the requisition to backfill that position. The next three are step increases for employees in our sheriff's office per the union contract. Then we have our new public information officer starting July 14th. Then we have the requisition changing the GIS and real estate position into a senior elections position in our auditor's office. Then we have a promotion in secondary roads. and the requisition to backfill that position. Then we have a request for salary exception for this employee who's being promoted. Al would like to give a step increase once they complete the required training after six months, including as long as they have a positive performance base. Then we have a retirement also in secondary roads. We have an end of employment of a part-time paramedic in EMS, then the requisition to backfill that position. The last two are receiving files. We have the 7-1 payroll change form for VA and an end of seasonal employment for conservation.

Questions for Beth?

I move to receive and file the conservation and VA payroll change notices.

Second. Is there any discussion? All in favor say aye.

Aye.

Aye. Motion carries.

I now for an approval of the balance of the payroll change notices that are presented.

I'm not going to be able to second that.

Dies for lack of second. Discussion? My only question was, has the auditor talked about how the GIS position is going to be fulfilled if we change this to this position?

He just sent me how he would like to update his job descriptions yesterday. But I was out, so I haven't had a chance. I've started reviewing them this morning.

I'm not comfortable approving that one until we see more information. Okay, did you have questions on any other?

Well, I haven't had any more information since our last discussion on this position.

So you'd like me to pull that requisition?

I would.

Okay.

I'll move to to approve the balance of the payroll change notices with the exception of the auditor's request for that position.

Second. Any discussion? All in favor say aye.

Aye.

Aye, motion carries. We'll move down to item eight, capital projects. Is there any capital projects today?

Nothing today.

Okay, great. We'll move down to then, ITEM NINE, THE DRAINAGE DISTRICT MAINTENANCE PRESENTATION. GOOD MORNING.

MY NAME IS TYLER.

IS THAT MIC ON?

There. Light went on. OK. My name's Tyler Buhman. I'm here with Jacob Hagan. We work with Agrivia. We do drainage district engineering work. So as directed by the board, we put together a report just briefly detailing essentially the conditions of all the open drainage ditches within Dallas County. It's pages long. You know, you can feel free to peruse more of it and ask us questions more in depth later on if you need to. I'm just going to kind of roll through it very briefly. Summarizing, we found 14 different drainage districts within your county that have some form of open ditch facility totaling about 35 miles of length, and The majority of these have trees and shrubs of some kind growing within them. That's typically not something that you would like to see in the long term. Trees, they cause maintenance issues, shading out grass. It can increase erosion and block maintenance access. It's a very common problem throughout the state. And when it gets very bad and is let go for a long time, these projects can be rather expensive to remove them, especially if the ditch needs a clean out or something. As part of looking through all these districts, we also found 18 different districts that have some form of a bulkhead outlet structure that also has trees growing on or too close to it. Those tree roots can cause damage to the pipe and the bulkhead over time and repairing those is also very expensive thing dealing with those concrete walls and pipes. And There's also numerous areas throughout the county where we found tiles going under zones that have trees growing on top of them. A good example would be the bike trails. Trees have grown up alongside them in the past decades, and they have lots of drainage district tiles crossing underneath of them. Tree roots getting into the tiles are very expensive fixes. So all that being said, we're here to talk to you about our proposal. how to manage this moving forward is we would like to recommend the county put together a spraying program similar to the neighboring counties, such as we just did a similar project in Greene County where we put a bid package together listing every drain that has a ditch that needs sprayed for trees. This is tree only spraying. And then solicited bids from contractors to do it. And usually this is done on a three year rotation. So we would do the entire county every three years. And this is just a very relatively inexpensive way to avoid the problems just getting worse in the long run. So I guess that's item number one. number two is We are proposing doing a GIS digitizing work throughout the county so that we can actually show on the maps such as beacon Exactly where these drainage lines are there would be what district they are how big they are and where they're located this would be really helpful for us and as the watchman and contractors and farmers so they can figure out what's actually out there all your records have been scanned in but to our knowledge none of them have been digitally mapped out we've gotten a decent chunk of them done already just through watchman work every time a watchman request comes in and we need to figure out where it is and what the problem might be we've kind of been slowly working on drawing these things in. We would like to see the rest of the county mapped out. I just think it would be helpful for us and the rest of the public, I guess. Third thing that we talk about in this report is doing a tree removal project. This goes beyond the preventative spraying maintenance. This would be, once we have all these districts mapped, if you so choose, we would then be able to find all the zones where you have drainage mains going under trees, for example, along the bike trails. And we would highly recommend doing a project to take those trees down in those zones, certainly along those public stretches like the bike trails or any roads or anything like that, where you won't get unlikely to get any pushback from from landowners because it's not on private property so that will save expensive repairs in the long term so then moving on from that the next step up if you wanted to go this far would be taking down trees along these open ditches Generally, it's it's an accepted standard repair Technically speaking the board's supposed to keep the open ditches in good repair and allow for maintenance access trees get in the way of that Obviously we understand this would be a much larger undertaking And we would want to have Lengthy discussions public we'd probably would like to have a big public hearing even with any landowners that might be affected in such a thing and long before moving forward with a full proposal. And there's different ways we could do it. We would likely come up with some kind of total bid package broken down by district. And decisions could be made at that point, whether you want to do this one or all of this one. so on and so forth because the states of the tree problems in the different ditches are different. Some are huge, massive, decades-old trees. Others are smaller shrubs that would be much easier to take out. I guess I just kind of rolled through it. Any questions about what I've said so far or anything you'd like to add, Jacob? Okay.

Can you talk a little bit about what you've flown with your drones?

Yes. Thank you for reminding me. So we drone flew with this report every open ditch that you have in the county. And those videos are posted on our Agrivia YouTube page for anybody to see. That just kind of helps us get a real handle on the conditions that are out there. Otherwise, you would just be guessing mostly from Google Earth photos. And The advantage too with that is that if you move forward with a spraying program or even a larger tree clearing program, these contractors can put eyes on it and should be able to give you a lot more accurate estimate of what their work's going to be.

So do you have like an estimate of what the GIS digitizing would be?

Yeah, a rough estimate to complete the work all the way to the end. would be roughly about $20,000. So you would split that amongst all the districts. It averaged about $200 to $300 per district to do that work.

And you said you did the tree spraying project in Greene County?

Yes.

And have you started it?

It is complete. Yep. They did it this spring. So if you move forward with a spray program, we would recommend putting it out for bids for work next spring. Spraying in the spring when the vegetation is down.

Which during each districts are in the worst condition?

So DD 10 came to mind to me as probably the most egregious one that I saw. I want to say that ditch is around four miles long. And if you scroll to it on here, maybe you can get an idea of what most of it looks like. There you go. It is chock full of evergreen trees along most of it, in the banks even, which is even worse than usual. A lot of times trees are just up on top of the banks. That's probably the worst one I could think of. That would cost the most to clean up. None of the other ones are that bad. Most of them are spotty in places. DD19, I know, is another one that, if you scroll down, has some pretty old growth trees. This ditch isn't particularly long, but a lot of it looks like that. I will say there's a special case too on DD8, which is Beaver Creek, basically where it parallels Highway 141. There's technically a drainage ditch and it is a complete forest, but we would not recommend doing any kind of work there, seeing as the district's effectively idled, hasn't really been maintained since it was built. meandered all over the place outside of the original banks. And the cost would be enormous for very little benefit, in our opinion, unless landowners really wanted to do it.

Do you have any other questions? We need time to think about this.

Yeah, I'm just now reviewing this. Yeah.

A good example might be worth taking a look at is if you go to the Green or Boone County Beacon website, they have drainage layers, and you'll see... what yours would probably look like. I will say that what we're putting together will definitely be more accurate than what they have. Just through use of it, they tend to have a lot of lines on there that actually are not drainage districts, or they're mislabeled, or they're not really in the exact right location, but it's a good estimate of what you would see. And that would be available publicly to anybody. In terms of the mapping.

Sure. Did you have anything else right now?

Yes. Every tile will be mapped out.

And this information can actually be put even on, there's a special app you can use where it'll physically locate you in the field. So when you go walk out there, you'll know, oh, I'm standing right over this 12-inch lateral, for example. And it can steer you around that way. It can be very helpful for people if they're trying to hook private lines in or anything like that.

In general, I think these are all good ideas. We've actually had requests from landowners to look at these things and do some of them. So we should have some serious consideration.

I agree. So should I, but I want you to have time to look at it a little bit more.

Let's bring it back next week.

Is that okay for you?

That sounds good to us. Thank you. Thank you. All right.

Okay, we'll go down to item 11, board appointments. For the Veterans Commission.

Good morning. We had five applicants for the Veterans Commission opening. The Commission reviewed those, and based off their recommendation, they recommended for Natalie to do another term, and Chuck Thompson resigned his commission due to some medical issues, and so William Horne was recommended to fill in his remaining term.

Any questions?

I move to adopt Resolution 2026-0083. Second.

Any discussion? All in favor say aye.

Aye.

Aye. Motion carries.

Thank you.

Thanks for the work on that. We'll move down to Item 12. We're setting time and date for public hearing for IP Pathways Bandage Technology Services Contract.

Good morning. This would be a superseding contract to take over our storage as a service we already have, our VEEN products and adding on our items we budgeted for for disaster recovery moving forward. So we would get, we realign the services and those other contracts, this takes that over and adds on the others and bring them in together under one contract again. It's a three year contract, that's why we're having the public hearing, and when we look to set it, I'm gone the week when it would typically fall to have that, so if we could push it to the week of the 14th. So July 14th? Yeah. 9.30 a.m. I guess I'll add Ben's reviewed the contract already, so.

Yeah, that's what I heard, July 14th at 9.30.

I move to set time and date for public hearing for the IEP Pathways Managed Technology Services contract from July 14 at 9.30 a.m. here at Sherman.

Second.

Any discussion? All in favor say aye.

Aye.

Aye. Motion carries. Thank you. About six minutes before our public hearing, so I don't want to jump into the workshop. First aid kit, do you think we can talk about that quickly? or to start the conversation.

I mean, we sure can. Do you want to? kick it off anyway.

Sure. So I think it's been almost two years now that the board had asked kind of to form a little safety and security committee and do some safety and security assessments around the county at the facilities. So we have completed those and I think we came to you several months ago to talk about some of the things that we had recommended and one of those was first aid kit compliance and getting first aid kits. that meet the OSHA and ANSI requirements in each of our office buildings. So we met with the only vendor that we could find and a vendor that is used by Rhodes and the Sheriff's Office, CENTOS. They came out and they walked with us to every county building Every county facility we talked with some of the department heads of those buildings to kind of see what that would look like To get us up to up to speed I guess with several things, but today we're just talking about the first aid kit, so We I guess just want to have a discussion about who responsible for keeping those first aid kits up and if we some of the first aid kits that we have have not been maintained so how we're going to continue to maintain them and just kind of come up with a plan or a strategy for what that what that looks like moving forward if we go with internal or if we want to look at having CENTOS provide that service for us. So I guess questions or thoughts to start our conversation?

We also had Ben do some, and Ben discussed this at the last time we had this conversation in this room about what we are required to provide as far as first aid kit goes. Maybe from a legal perspective, it'd be best for you to summarize that again.

Yeah, last time we spoke, I mentioned that the county or the state of Iowa doesn't comply with OSHA, but it complies with Chapter 88. That was a little bit too legal, and the short answer is the county has to comply with OSHA. So, just because how the statute is written, it's written very funny, where the state reserves its power to determine occupational safety issues, but then it defers to OSHA. So long story short, the county does have to comply with the OSHA requirements as far as first aid kits and OSHA recommends the ANSI standards, which isn't necessarily a legal requirement, but it's a best practice and not complying with those standards would open up the county to liability from that perspective if for some reason something happened. Thank you.

So when we're not compliant now, you're saying, or some of them.

Well, I'm guessing.

As not as compliant as we should be.

Yes, that would be accurate.

We're not completely, yeah, I get it. So the service would... We're already using it for other things. So the service would keep them compliant. They would have all the supplies. We wouldn't need to be running out for Band-Aids or whatever it is. And they'd be on a rotation where they're looking at it.

Correct. They would, Cintas would come out monthly and do a check of the first aid kits. And then they document it as well, which is a requirement of OSHA ANSI guidelines. and then they would refill that. So our Sheriff's Office and Rhodes Department each utilize CentOS now because they have, so getting even deeper in the weeds, there are two kinds, there's a type A and type B, and they have type B first aid kits that are required due to their workplace environment, but the rest of the first aid kits are type A that we would need like office environment type first aid kits, so. Yeah, and they've been happy with the service. We've talked with both of those departments, so.

Oh, we do have it, but I, let me grab my. You've got about a minute, Lynn, and then we'll just have to break for the public hearing. Okay.

Yeah, so to purchase a first aid station, and that includes the signage and the 32 required supplies, it is $350 one-time purchase. And we need 12 of them. We currently have 12 that are compliant. So that includes like two here in the admin building, three out at human services. We looked at putting them in break rooms because they're employee use. FOR STATE KIDS. I'M SORRY. I'M GOING TO HAVE TO JUST STOP YOU THERE.

WE HAVE TO OPEN UP THE PUBLIC HEARING. SO WE'RE OPENING THE PUBLIC HEARING ON THE ZOL STRIKER PREVENTATIVE MAINTENANCE AGREEMENTS. THIS IS THE PLACE AND THE TIME FOR THE PUBLIC HEARING AS ADVERTISED ON THIS MATTER. HAS THERE BEEN ANY WRITTEN COMMENTS ON EITHER ONE OF THESE TOPICS?

NO.

AND KRISTEN? NO. OKAY. AND DO YOU WANT TO go to the podium, speak about them briefly. And then we'll make sure, if anyone has any public comment, they can comment.

OK, so the Zoll preventative maintenance contract would cover our cardiac monitors. This is a piece of equipment that we use on every call. Defibrillation, pacing, 12 leads, blood pressure, CO2 monitoring, CO monitoring. SPO2 monitoring. It does all the things. So they'll come in annually. This is a three-year contract to make sure that everything is working appropriately. And they'll document that and keep records of that. And then the second one is the Stryker Preventative Maintenance Agreement. This will cover several pieces of our larger equipment, our power cots, as well as the power loads that we use to get patients in and out of our ambulances. And then the Lucas devices, which is our automated compression devices that assist us with CPR. And this is also a three-year contract. And both have been reviewed by the Assistant County Attorney. And revisions were made, and we're happy with the result.

OK, we are in public hearing. If there's anyone who would want to speak to this topic in public hearing or board members. I just have a question. Oh, go ahead. No, you go ahead.

Kristen, who inspects and maintains our AEDs?

Not us. I mean, we don't have any AEDs in my department. We're going to talk. That's, yeah.

I mean, it won't fall under one of these?

No, no.

Could it fall under? Monitor agreement?

I could ask the Zoll representative about that, but I think that they're proprietary. They would do Zoll AEDs, but I'm not sure that they would do all. I think most of the AEDs in the county, I want to say, are HeartSaver. But we do have a biomed company. That I'm working with that. I'm currently working with for preventative maintenance agreements on our vents They may be I could certainly ask them for It sounds like we're gonna get a little more information.

Okay. Thank you.

Yep and this was budgeted for it's in it's in the budget for FY 27

So these are preventative maintenance, but these are also the people you go to if something breaks down, right?

Right. So with the striker agreement, they also do – there's a battery swapping part of this agreement as well to keep our batteries healthy. And any time we have – any kind of issues with any of these pieces of equipment, then they'll come to us and do all the repairs on site and get us back up and running right away. The thing with any of these larger pieces of equipment is if they're not working right, then we're down the whole truck. It's a vital part of... WHAT WE DO. AND THEY'RE PRETTY RESPONSIVE? VERY RESPONSIVE. THEY HAVE BEEN DOING OUR PREVENTIVE MAINTENANCE. I'VE BEEN PAYING FOR IT A LA CART, BASICALLY. BUT WITH THIS CONTRACT, THEN WE WILL TAKE PRIORITY OVER, YOU KNOW, PEOPLE WITHOUT THE SERVICE AGREEMENT. AND THEY'VE BEEN PRETTY RESPONSIVE EVEN WITHOUT THE SERVICE AGREEMENT. But we pay for travel and we pay for miles and all of that when we don't have the service agreement. So all of that is included with this agreement. Yes, yes, it will. Yes. Like the Lucas, the last time we had one of them break down, and it would have been covered under the service agreement, but we didn't have it. It was $9,000 to fix it. So, yes. Yes. Yes, yes, they do.

Okay, we are in public hearing. Is there any comments from the public?

Are these exclusive companies for this? type of service, or are there others out there?

They, as far as for like the service agreement on the cots, no, not really. Not like this, not like apples to apples, it'd be more apples to oranges. I'm sure we could have a contract with somebody out there that would come in and do the things, but because any repairs that would need to be made, you'd have to go through Stryker to get the parts and pieces. to do the repairs. Any other company doesn't have that kind of ability to do that.

Anything else?

No.

Okay.

Move to close the public hearing. Second.

Any discussion? All in favor say aye.

Aye.

Aye.

Aye. Motion carries. Thank you.

Move to approve the Zoll and Stryker Preventive Maintenance Agreements as presented and authorize the chair to sign.

Second. Any discussion? All in favor say aye.

Aye.

Aye. Motion carries. Thanks for the work on that. We'll jump back down to the first aid discussion.

Yeah, so the first aid kits, I think we were discussing the pricing or cost estimate. They provided us, each new station would be $350, and we need 12. We have 12 that are compliant with the sheriff's office and roads departments. So it would be like a one-time $4,200 cost. And then for them to come in monthly and refill, they said that the average is $50 to $150 per kit. However, most of their kits that they provide service to have the oral medications in them, which we are electing to not have. So that price would likely be on the lower end of that. So the closer to the $50 or $75. So it would be an annual $2,000 refill for 25 or for 24 of the kits because we have 12 and 12. If we elect to do this as a County as a whole versus going by department They are providing us a cost savings and that will transfer to our current contracts with the sheriff's office and the roads department.

So Correct And then there's an annual fee for the monthly service or it's 50 bucks a month

No, they only charge to come and refill. If we purchase their stations for the $350, they come in and they will do the maintenance for us and the restocking, but we pay for the restocking.

Now I'm confused. If we don't buy their kit, Then there's what kind of a fee?

They will not service a kit that's not theirs. Correct, yeah.

For the one-time fee, they're in 50 bags.

Right.

They'll come monthly, and then the only thing you have to pay is to refill whatever you need.

Correct, yes. Or if there's expired items, and I can't remember what she said would maybe be, I think there's some antibiotic ointment that potentially could expire, and then after, I can't remember, it was five years, or after so long, they also replace the gauze pads if you haven't gone through them, stuff like that that just gets old.

$1,800 or $2,000 annual fee covers what?

It covers the restocking of any supplies that need replaced. Bandages, gauze pads. But you're paying for the item that they're replacing. And so that's why the fee can kind of vary.

And they come out and they look and they document that they have checked it.

Correct. So there's a shared liability that is in the contract that they would provide us to.

Lynn, have you talked to Hawkeye Fire and Safety?

We have not. So we found that Cintas is the only one that can provide us like the full package of things. But I mean, I'm happy to talk to them. if they can provide us that. And we weren't even sure what the strategy you wanted was, if we were going to do it internally, if we wanted to look external, or what that looked like, or if we wanted to even continue moving forward with the project.

Well, we need to be compliant.

Yeah, I can continue to move forward, but then... What was that other company you were saying?

Hawkeye Fire and Safety.

And if you have a contact, I would be happy to contact them. We were trying to find other vendors, and we couldn't really find anyone with this niche. So yeah, I'd be happy to contact them.

And I believe, if I'm wrong, I don't think the sheriff and Secondary Roads wanted to change. Yeah, they won't switch. They wanted to stay with Centos. So we were trying to get the whole county with one vendor. You said there was a discount if we all go with the same one. which is why we proceeded with SIGTO.

There may be a discount, but that doesn't mean that they're the most economical to use. Very true.

I was just giving some background information. Plus, it just shows that we're doing our due diligence to look into another one.

If they're still providing that service, I've been out of that for a little while.

What I'm hearing is, yes, I think we want to be compliant, but we want to do our due diligence for the marketplace.

Okay, sure. I can connect with you, and we can get information if you have it. All right. I can also do some Googling to see if I can find it as well.

If you just Google their company name, I think they're still active in Des Moines.

Okay, perfect.

So, if after doing this due diligence, it's determined that Centos, or the other firm for that matter, I guess, is the better option to go with, My recommendation would be that facilities be in charge of it, like be the point person for when they come to do their refills and checks and whatnot. They would work with facilities. And then from a budgetary perspective, I would want your permission or direction to include that service within the facilities budget. It's not currently right now. Or if you have different thoughts on how you would want to pay for that, whether it be Department 99, a non-ISF fee department, or facilities, which is an ISF. And then we talked a little bit just a few minutes ago about the AEDs. Once we get to a point where we need get a vendor on board for that to make sure that we're complying with all of that as well. I think that should probably follow in the same vein as this. Also a facilities expense or non-departmental, Department 99 would be another option. And then I guess that leads me to the next question is, so Secondary Roads and the Sheriff currently have them service their departments for the first aid kits. Do we continue to allow them to pay for that themselves, or do we wrap that all into one county expense?

I don't know yet until we know who the vendors are going to be.

And those are just the questions that I have.

Yeah, we wouldn't want their costs to go up.

No, right.

No, we'll bring this back when Lynn could let us know when you get some more information and we'll put it back on. Yeah, absolutely. No, good questions. Thank you.

Thank you, Lynn.

Okay, we are down to EMS Billing Workshop.

Good morning. I have with me Travis and Michelle Smith. with PCC, an ambulance billing company. And I see Eric and Kendra joined us as well. So try to get, I'll have Michelle come up and she's put together a really nice agenda to walk us through EMS billing, the health of our current EMS billing status. And then if you have any questions as we go, absolutely feel free to ask them. And then we'll just sort of do an overview of how it works on both sides, our side and their side. So this is Michelle.

Okay, thank you for the time today. I'm excited to be here. We actually have done the ambulance billing for Dallas County for almost a year, so we're ending, we ended in May, so we have one more month left. So, first of all, PCC is a local billing company, but has become regional. We're large enough now to bill for many services, but we keep a very close finger on the pulse of what's happening in EMS in the state of Iowa. And the reason why is because there's a lot of billing intricacies that are specific to Iowa EMS providers that if you know what you're doing, you do really well at it. If you mess up, it can honestly impact your income in a negative way. So we have done, we've turned things around a little bit as far as the reimbursement goes from the start of our contract. Initially, we had a little bit of cleanup to do. Just the Dallas County EMS as a whole, the provider status was under a probed targeted audit by Medicare, which can happen for any EMS agency. It wasn't because there was anything necessarily being done incorrectly. But they do target and probe providers to check your documentation, be sure that things are being billed correctly. Long story short is when we started, the prior billing company had already been in that audit for a while and really kind of phase one failed that. that probe audit. So we jumped in right away, completed that targeted probe audit, and worked with the EMS agency very quickly to provide everything they needed, so we passed. So a lot of that was due to Kristen's attention to detail, her ambulance crew, their leaders, everyone's education was brought, we did a training session for documentation, for all the EMS agency in the beginning, and that helped a lot as well. So anyhow, it really just got us on the right foot so that when claims were processed, they were processed correctly. From there, there were some contracts for EMS for Iowa Medicaid that had not been put in place, so we were able to maximize fee schedules as well. If you're not contracted with the Iowa Medicaid MCOs, you receive a 20% reduction, and at the time we started, you had not been contracted with the Molina payer which was the most recent payer and really the one that has the biggest footprint in Iowa. So we completed that and that obviously got us on the right page so we were maximizing reimbursements for claims that your provider was sending out the door. So that's a little bit of the overview that we had in the first year. The other, basically what we've provided is some reports, and I don't know if you want to pull up some of the reports. To begin with, we provide the practice analysis, and it might be, I'm not sure the order you have them, but the practice analysis is probably the next one. Oh, there's our invoice. I don't know how that got in there. Yep, keep going. There's probably another one.

Yep.

Okay. As you go through, I'll, this is the one. This is the practice analysis that shows you the view of our month.

So, based... That's not there. That's the payment analysis.

Oh, okay.

So, one more. One more report. I don't see the practice. Hold it.

This is, there's one more. There's actually another one.

This is the, yeah.

So when you receive reports on a monthly basis, we give you an overview of what happened for the month. Basically, the top of this shows you the charges. For the ambulance specific, the average for the year is you're really transporting, your total runs is about 270 to 300 per month. We do enter 100% of all your tickets so that everything is accountable, okay? So the total runs here for this was an April view was 255. You can see there was 91 no-charge tickets. That's how many times the ambulance can be called out when no bill... is completed because either service wasn't provided, patient refused, canceled call, things of that nature. All of the other responses are categorized based on the level of service that we provide, okay? And we have another report that will give you sort of an average of what ALS versus BLS is for the EMS. If you page down just on this report to the bottom half, then it sorts out really what happened on the payment side for the ambulance provider. And we kind of wanted to just be available to answer any questions so you guys can kind of see what your performance is. So this summary just kind of tells you all the entries that were made for the ambulance agency for that month. At the very bottom on the right side, it shows you what our total balance forward is. That's your open accounts receivable, active accounts in our system that have not been paid yet. So keep in mind that would be new charges in there as well where contractual adjustments for a Medicare or Medicaid claim that maybe haven't been taken yet because the claim hasn't adjudicated. So, that usually can be anywhere from half or almost one time your annual income. You got, this is less than half of your annual income. So, we have a very clean accounts receivable right now. Anyhow, that's what this report shows you specifically. Let's see. What? I think this one we passed already. So if you go back to the beginning, the report I'm looking for is level of care. The level of care report will show you just how many ALS versus BLS transports. And I think it's after this one. So one more. That's OK. No, not quite. That one. Okay, so this one just summarizes for you advanced level service. There's different levels of service and different levels of payment that you receive. So ALS-2 being the highest level of service provided, ALS emergency is advanced level service, and BLS, anything in the BLS would be basic level service. So you can see on an average 66% of the time in advanced life support, services being billed for, provided, and billed for. Okay? So our service will drill down to each patient care report, assess the patient, the level of care, and bill at the appropriate level of care that's documented on each patient care report. Anyhow, this is all data that goes to you, goes to your ambulance crew and their director so that they can really see how we're capturing payment for the services that they provide. Okay. Then let's go to the insurance aging to just give you a quick view of how clean your account is at this time. The insurance aging will have some insurance companies on the left side, and it will show and aged category. So this is your insurance accounts receivable by insurance payer. So at the top, it's self-pay driven. You can see 26% of our outstanding balances is just in the self-pay category. And then at the bottom is all your insurance aging balances. And this changes. This is just a snapshot in time. So this changes on a daily basis with payments and things of that nature. The very bottom kind of shows you a little bit more of a report card. At this point, most of your balances are in the current column, 77%, and there's some trickled into the 30 days, 90 days, 120. With everything getting smaller, the older it gets. So basically, what this is showing you really is that Your insurance is not sitting there for any length of time. Things are getting paid. If there is something sitting in insurance, it could be a payer that takes a little longer to pay, or it could also be, you know, an appeal or something of that nature. So that's what that report shows you. And I really just kind of wanted to give you a few reports and then just give you some discussion time in case you guys have specific questions about the reports that we've provided. As far as fee schedules and reimbursement rates, I'm gonna kinda move on to that section three. At this point, we have taken the fee schedule for the county and applied that to your billing. So rates have not changed since we started to do the billing. At this point, what has changed, though, is your reimbursement on a month-to-month basis. And if we back up to the report that summarizes this one right here. Yep, the financial summary really shows you a real big picture of what your reports, what your months look like.

So on an average, up here, you can see this is your total payments along the bottom.

When we started to do the billing, really your total payments on a monthly basis had been decreasing on a regular basis. and they've actually been on the increase on a regular basis now. So we're maximizing income, billing claims at the correct level of service, and so the income on a monthly basis is reflected. Okay, so as far as a fiscal year outlook, we really expect to end the fiscal year at what we forecasted when we started to do the billing a year ago because we're tracking on a monthly basis to make sure that each month is being reimbursed at the level that they should be. Let's see. Is there any questions about the reports that we've talked about so far? No?

Yeah.

Oh, yeah. Question.

So where are the adjustments between the billing rate and the reimbursement rate? We're not collecting what we assume our costs are. Where does that reflect?

On these reports, the contractual adjustments you'll see on this one here. The third line below. You're contracted with Medicare and federally those are obviously decided based on Congress what the reimbursement rates are at this time. Congress has, Medicare has indicated that in the future, and it could be in the next five years, that they may be changing the way that they do their reimbursements to ambulance providers. A couple years ago, ambulance providers had to do cost reporting data and provide that to Medicare. So they're working on a way to pay ambulance services more based on the cost of what it does, what it costs you to provide the service than the fee schedule. The fee schedule has been in place for 30 years, and so we don't expect their fee schedule to cover costs as costs have changed. So anyhow, that's a good thing, but it's not, it's on the horizon, but it's not that close, so we still have to pay attention to what we actually get reimbursed based on the current fee schedule. There is, in Iowa, there is in place that ground emergency medical transportation, it's called GEMT, cost-based program. It is intended to supplement Medicaid reimbursement, and it does. And so anytime your ambulance transports a patient, that program will pay an additional amount on top of their fee schedule. And so that's helping to come in and supplement those costs for providing the service. So, GEMT is helping. I don't know if the board's aware of the GEMT program, but that's why those Medicaid transfers are so important for you. You know, we came in and did a training with the EMS crew, and they understood and were on board immediately. But their, you know, call intake, how they document those patient care reports, and the specific information that they're indicating really plays into billing on every single trip. And so our intent was to capture every reimbursement that you were applicable to receive, which is what you should be wanting. So that's really what we started with, was training and making sure all the programs that you were eligible to be reimbursed for that you were capable of doing. So, you know, some of those contract payers came into play with Molina. So we did all of those things. The contractual adjustments is entered at the time that the claim adjudicates, not before, so that you can see when the payment happens, the contractual adjustment happens, and only the balance that's left for the patient's secondary is left on your accounts receivable. So sometimes, and if you scroll just to the bottom of this page, sometimes that total accounts receivable, or I guess it's the middle, I'm sorry. which is highlighted in gray, that 632.985.13, that was your ending accounts receivable balance at the end of April, on April 30th, because this was an April report. It sometimes looks really inflated, but if you go to the very top of this report, you can see the new charges just for April were on the right side where it says charges. It's 242.560.43. Yeah, May. I was, okay, so this is a May report. Anyhow, but that $242,000 is all new charges that includes the contractual adjustment. So of that 600, you can see new charges in there as well as pending claims to pay. So you have to understand that accounts receivable balance does include some contractual adjustment that hasn't been taken yet. So actually, your account is really clean in regards to open balances.

All right. So then policy-wise, then, when you get to the aging of the accounts receivable, at what point these were not going to be able to collect some of it?

We collect everything that's insurance balance, period. We don't let anything time file. We don't write anything off. If the balance goes on to the patient as a patient responsibility balance, we do bill claims for patients for any length of time if they're making monthly installments. So if they're paying on a monthly basis, we allow that until they pay the bill in full. But if they don't pay the balance, You know, they'll receive a bill for 120 days, and then that unpaid balance is recommended to go on to a collection agency or collections of your choice. So...

So it's written off of these?

It will be, mm-hmm. And then it comes back over either to do collections in-house, small claims, or utilize a collection agency or the Iowa set-off program for unpaid balances.

So... All right, so you are... managing those. So at what point do you turn that over and say we're going to do it ourselves?

We usually at that 120 days after it's become a self-pay balance. If the patient's insurance pays half, the rest is their responsibility. We do send them a current invoice for 120 days, so four months. On the fourth month, we do a past due process with them, which means we check everything. We check... demographic information. We check hospital, do you have insurance that wasn't reported to us directly? We have skip tracing programs that allow us to check insurance. That's why we've worked with the crew very closely and Kristen has worked with her crew very closely to obtain current demographics, date of birth, and social security number for patients because it can be vital in the collections process. With that information, we're able to obtain insurance even even after it becomes a self-pay balance. But if it is truly a self-pay balance and the patient just hasn't paid their outstanding balance due, then that claim will go on to the collection agency after we complete the past due process. And self-pay balance is due. So it would be 120 days after the self-pay process starts. Yeah. So patients have a lengthy amount of time to satisfy their outstanding payment that they have open. Once we take it off the accounts receivable, when you guys see this report, it would be still monies that we expect fully to collect.

Well, great. So when you talk about including the report, well, yes, we keep writing off some at the end that's not collectible. Excuse me. Yeah, it's going to stay clean.

Yep, you'll have two accounts receivables. You'll have your current accounts receivable that is expected to be paid on a current basis, and then your collections bucket. These are patients who haven't paid their self-pay balance and there's a separate process for them. There isn't insurance involved any longer. There isn't eligibility requirements. It's just what amounts can that patient pay. And so then that collection balance will be a separate accounts receivable that you'll have. We aren't a collection agency. We do the billing process very well so that that process you can depend on that income. As far as collections, then that is referred on to whatever process you want to utilize afterwards.

Ben and I have been working on that process, the collections process. So if you have questions about that, Ben and I would be better to answer as to where we're at with that.

It's outside of this presentation, so different program.

Sure.

Yep.

Okay.

I'm not going to mention the bad dad right offline. You guys can see the amounts that are actually written off to a collection. They're off our books. About the second line down, it says bad debt write off. That line is the dollar amounts that are written off to the collection process. They're off our books, and now they're on to somebody else to do a secondary process.

So and it could be five accounts that month. It could be 10 that month. It just depends. So you'll see a pretty good batch in February and then in April a small batch. But overall, I think those were the two batches for the year. So that's really your collection amount over time.

So let's see.

So, you mentioned, we talked a little bit about Medicare. Medicare obviously is a fixed fee schedule. Iowa Medicaid is as well, but we have that GEMT Supplemental Payment Program that comes in. Basically, any other payer, we're expecting 100 percent of what you charge to be reimbursed to you for payment. And then, of course, it's your self-pay. Those are your categories. As far as we talked about total accounts receivable on the year and aging amount, the fiscal year forecast, I mean, we really see regularity in the month to month as far as reimbursement goes. And we expect to finish this first fiscal year at what we estimated for income. So the first year has been a good year. I don't, is there anything else you wanted to touch on? I think that's pretty much a good overall view of where you guys are for now. So, do you guys have specific questions about reports?

How do you deal with the insurance carrier that comes back and says, hey, look, your charge is outside the customary

Usual and customary?

Usual and customary charge.

If you're not contracted with that insurance company, the difference between the paid amount and, well, anything that is a balance after the paid amount is billed to the patient as their responsibility. And you're able to do that as an ambulance provider. Unless you contract with them and have a contract with them, the remaining amount is patient responsibility.

You don't go back and ask them for their data that proves that your charge is outside the usual and customary charge?

Commercial insurance companies like to list it as usual and customary.

Often?

Often. I mean, it happens on just almost every EOB. It doesn't necessarily mean you're overcharging. It just means that's more than what they want to process for payment. We typically recommend if the patient doesn't agree with their outstanding responsibility, we recommend that the patient we can get the patient on the phone with their insurance company and talk through their discrepancy. But it really is the insurance that they pay for. And so most often, we do have a couple pairs. I don't have to mention them by name, but a couple will reprocess the claim once you have the patient on the phone with them. And then they will offer additional payment for the provider to reduce the patient's self-pay responsibility. But it is not the provider's responsibility to write off the difference between the usual and customary and the patient self-pay responsibility. So it's a good question. It happens a lot.

I also didn't see any SCT charges recorded. Is there a reason for that?

SCT, because you would, SCT are hospital to hospital transfers. at the scope of practice beyond the scope of a paramedic. So if you didn't see any, there wasn't any that we would have done at that level.

That's not quite accurate, but a paramedic can provide SAT transports.

They can, but we can't bill for one unless the scope is beyond the scope of a paramedic. It can be a critical care paramedic that would be able to provide that level of service.

And we have critical care paramedics. Yes. And you're using ventilators?

Yes, but we have not necessarily used them outside of this, into the critical care paramedics scope. Ventilators are in paramedics scope.

Yeah, so if a paramedic can do that level, then we have to bill at the ALS level, not the SCT.

ALS 2 level.

I mean ALS 2, yes, right.

Yeah, so when ventilators originally became part of EMMO, sorry. That's okay. Um, originally ventilators were under the CCP scope, but that has, that has shifted. And so, um, they are paramedic level. They're paramedic scope now. I mean, there's other things, there's other things like a balloon pump and things like that, that we don't do out of the Dallas County hospital.

Okay.

but we do clarify those because we wanna know, we wanna be sure that we're capturing that highest level of payment when necessary or when possible. So if we ever had a question about the scope of practice, we definitely would clarify it before billing. And we have an open communication, really. We work very closely with Kristen to be sure that the level of services that are provided are billed correctly. Not just for reimbursement reasons, but for your patient's experience. You really want your patient to understand that the level of service that's billed on their claim is correct. So when they get a bill, they understand it, and it makes sense to them. More often now than ever, patients request copies of their patient care reports, and so we're not afraid of that. We want them to, you know, fully be aware that that's going to match the rate and the level of service that was billed for them, so.

Are you able to provide other reports other than what you're providing, Kristen, at this time?

Yeah, we have all kinds of options for reports. If there's something really specific that you would like to see on a regular basis, we're absolutely able to do that.

Could you provide a list of reports that are available to us?

We can, yeah.

That's usually my job.

Yeah, Travis is here. He's the report. But yeah, if it's something very specific that you would like to see, we can certainly do that. So really, when we started, we just really looked at the opportunities for reimbursement. Fee schedule may be something that you want to look at in the future, not We always are just real reactive when a provider wants to really go into a fee schedule review. A fee schedule would allow you to maximize reimbursement for things that do bill outside of that contract, right? So it's not going to affect your payments from Medicare, from Medicaid, from Iowa Medicaid. Those things like that. However, there are some key things that you're not currently billing for, which one is disposable supplies. You can build disposable supplies when they are applicable for insurance companies that allow you to build them separately. And since COVID-19, a lot of your supply distributors or the places where you're purchasing your supplies have raised their rates. So supplies are costing you more than they ever have in the past. And so there are ways to recoup some of those costs in your billing. You can't bill for supplies across the board to every payer because Medicare pays you for base rate and loaded mileage only. Blue Cross pays for base rate and loaded mileage only. But there are a bunch of other commercial work comp, liability, VA, a bunch of other payers that will still allow you to bill supplies separately when they are used for that particular patient. So there's an opportunity for some reimbursement change. Doesn't mean you have to. I'm just kind of putting that out so you have that awareness in case you decide to do a fee schedule review. And that's part of what we recommend. Then you kind of have some understanding of why that is. It's because if you don't put the charge on the claim, it won't get paid. but if you put the charge on the claim and it's applicable to that payer, then it will pay based on what service was provided for that patient. So we're really only capturing a certain amount of reimbursement right now because we're not billing for supplies separately. So that would be oxygen, IVs, um, you know, disposable supplies, EKGs, things like that. So, um, so yeah. Um, any other questions? I appreciate the time to talk with you guys about the billing process and the reimbursement and how the reports come out. But if you have specific questions, we can certainly answer those anytime. And I'll look forward to providing a list of some additional reports you might want to see.

I haven't done the math yet, but you know what your rate of collection is?

I think the rate of collection is on there, Travis. Do you have that on one of those reports?

Yeah, there is a report called the Annual Collection Statistics that gives you...

It's one of the reports.

It's one of the reports.

And is this before or after your Medicare adjustment or Medicaid?

So it gives you both gross and net.

Okay.

It's got a whole bunch of lines crossed by month.

Not one that we've landed on yet, so.

Yeah, I think it's a little further up anyway.

Okay. Page 26, I think. Annual collection statistics. Yep.

I thought maybe we were.

Who's running the clicker?

Yeah.

Yeah, that's the report. All right. So the second page is kind of the summary of the whole year of all the report, and everybody likes a nice graph at the bottom. But really, the summary line there, that gross collection percentage, 43% is what's collected right now on this report. This is kind of obviously a snapshot. And like Michelle was saying earlier, it includes all of the current charges. So those haven't actually paid yet. But then when you take the contractual adjustments off, right now we're at 75% net collections.

And that actually is probably a lower number, and some of that is because when we started to work with you, we did take the old accounts receivable. So we really went through their, at the time we onboarded patients into our system, we went through as best as we could to sort out what accounts were still open and available to be billed for. And a lot of their self-pay balances really had to be scrubbed and worked through and those got pushed into here. So some of this report card is before us, right? So a lot of that stuff we pushed in.

When do we start looking at your report card?

Well, our report card is overall, it really is, but we're pulling in balances that were old because we wanted to do everything in our power to still collect things that even your old billing company didn't collect.

And you're finished with that?

I wouldn't say we're 100% finished. There's still some patients that we have.

If you scroll up, you can look. We literally started in July of 25 with all of the trips. So if you look at that line, the July 25.

So we were billing claims all the way back to 2024, January 25. All of our stuff started here.

So if you look at that line. So this report. We kind of have two kinds of reports. This report literally is everything that happened, all the transports that happened in July. These are all the payments, adjustments, everything that happened on that line are for those transports.

For these dates of service. So August 24 dates of service, there's still, you know, there's a credit balance out there. Or no, yeah. For August 24. October 24. So January dates of service in 2025. we found there was still $3,800 of balances to be paid to you that the old billing company didn't get paid, so we forward balanced them into our system. So those do still affect that collection rate. And it's kind of unfairly, but that's the way it is. If we pull stuff in that's old and try to still get those processed and paid for you, it shows that we didn't do it. But that's because it was before our time.

So really things started- So just look at July 25, you can see the- You know, the total charges for those transports, the total payments that have been collected for those transports.

So ours is right here.

Ninety-four percent has been collected. So there's still self-pay balances out there that are paying for July of 2025. All right.

Thank you.

Yep. So thank you for your time. We appreciate it.

So in the, when you look at trends of things, kind of like we just discussed, talked about, when you see a red flag, you're contacting our manager and say, hey, you need to look at something?

100%. If we have a question, we are, it's really a PCR verification item usually, but it could be anything. Kristen is very cooperative and we have a very, I wouldn't say constant relationship, but a weekly and daily and You know, we very much have a hands-on relationship because you want anything to be validated prior to billing. You want your claims to be going out completely correct and verified, that kind of thing. So they're very susceptible. In fact, Kristen was amazing. She inserted... you know, a level of leadership that we add contacts to as well so we can send out provider requests and they answer those on a regular basis if there is any. You know, we always have a lot of contact in the beginning because we're establishing our processes and then things kind of go according to, you know, like clockwork, but we still have that communication available. Absolutely.

So a key best practice for our crew is to do all this documentation correctly. So...

They have to complete their documentation within 24 hours of a call is the expectation. And we audit those reports daily. The crew chiefs do. So within 24 hours of a call, the report is completed and reviewed. And if there are any corrections that need to be made, they're expected to be completed at their next shift.

So a training for the folks doing the work is ongoing? Ongoing, yes.

It's part of our what's called continuous quality improvement process and the report auditing process. And it encompasses not only the billing side of things, but also patient care. So that's reviewed daily. So they're getting constant feedback. Constant feedback, yeah.

So when does PCC get the trip information from the crews?

Every day. So once the report has been reviewed by the crew chiefs, it is determined to be ready for billing.

And then the crew chiefs send it on? Yep.

And then within 24 hours, it comes into our system. And then you'll have an account manager who then does look at all of the compliance for the billing side. They'll look at the compliance requirements that the patient care report needs to meet. And then, obviously, we have an ability to elevate questions back if we need to. But otherwise, we send them off to billing.

And how often does that happen?

Daily. How often do we request things?

Yes.

I would say a year ago it was more often. It's not as often now. Not as often. No. I mean, there might be one or two in a week if that.

We had to adjust a few things within our EPCR so that signatures were being obtained properly. They weren't necessarily obtaining the signatures in the right section of the signature sheet and things like, so there's been a lot of sort of those little things. And then, you know, people forget, they fall back on their old ways and they have to correct things, but it's less and less.

That targeted probe audit that Medicare was doing in the very beginning, At that time, the payer, which is Medicare, they were focusing on authorizations to bill insurance, which was your patient signature. And that wasn't just in one. I mean, we billed for hundreds of providers. So we could see across the region how that was being done. It wasn't just one provider. It was many providers that that was happening with. But it did really teach providers how important those authorizations to bill insurance were. signatures are that they obtain from their patients on a daily basis. And so they do a lot of that documentation perspective and qualify that before it even goes to billing. And then you have that tiered level of overview we can check and make sure because we're the ones who see when it is audited what they're looking for. They don't, you know, crew members don't always get to see that because they're not on the billing side. So you have that second level of compliance inserted into the process as well. So it's really great. On our claims processing, second level of your question, how do we look back? How do we check things? This report tells on us. This report tells us of the pending money, what are the dates of service? So we can hone in on this month and go, hmm, what is that $20,000? We need to work that right now, meaning look up every single claim and make sure it's doing what it's supposed to be doing. So on the billing side, we do the same thing. We go in and go, where is improvement needed? What can be done? If that's all self-pay, then obviously those will be on their way to collection probably. But if it's insurance billing, then we hone in on those and make sure that nothing's needed, nothing's going to expire. Time filing limits are two years like they were 27 years ago. They are now a year, six months.

The VA is 30 days.

The VA is 30 days, so we've even had to insert billing processes to capture billing inside of 30 days because the VA expects the claim to be there and you have their patient's social security number and or they don't allow payment, so. We have to jump through some hoops for specific payers to be sure that we get those captured as well. And we've never had one-time files, so that's great. So anyway, but it does, it needs a coordination from both sides in order for everything to work really well. So that number at the bottom of the report, we were saying we were averaging that 100,000, 125, some months it's 150,000. It does not happen by accident. It's a very coordinated effort. And so we've plugged a lot of the holes, a lot of the missing opportunities that we had in the beginning before our contract started. And that is the reason why that income is orchestrated on a monthly basis. So if it drops drastically to $30,000, then something happened. Something's not right. But we're not going to let that happen.

So, does the crew member determine whether this is an ALS or BLS transport?

No, we, the crew chiefs determine that based on documentation.

Okay, so if the crew chief says it's an ALS transport, PCC, you get the trip information, you're doing your audits. If you see that it's not an ALS transport, what do you do?

We send a note to Kristin and says, hey, can you review this PCR? I see there's a discrepancy and I need to verify the level of service. So we, prior to billing, we verify that level.

And you do that on all ALS transports?

We do it on every trip, if there's a discrepancy on every.

Well, you look at the BLS and say if it's ALS, you'll change it to an ALS.

Yeah, this is marked BLS, but clearly a medically necessary ID was administered. I think this needs to be ALS, so yeah.

And is there a report that shows when you receive the trip information, and when you bill it out to the insurance carriers?

I don't know if it shows that. We're working on that, actually. What the industry is going for now is a little bit more transparency. They're not talking so much about collection rates, but they're talking about time to submission, time to initial claim submission. So we're kind of working on a report. I don't know that we have a report right now that says that date. But because we know the history at Dallas County, and we know that income is really important, obviously. It's important for everybody. But your claims are being entered as soon as we receive them. But we can work on a report that would provide that. That's just not something that's in our wheelhouse yet. But we've already seen industry standards want that time to first claim submission. So yeah.

Some of these reports that we have, I mean, there's certain limitations of what we can do with them. But we're developing a dashboard that's going to be online that's programmable so we can start pulling more data fields. Some of these reports don't have the ability to calculate sometimes, or at least it's above my pay grade. So we're developing a dashboard, and that's one of the things I think that we're going to look at. is how long does it take us to get them? Like, the data service is this. We didn't get them for two weeks. We got them billed out. Three days later, they paid. The first primary payer paid within 14 days. So those are kind of data points that we would like to know as well.

You have a timetable for this report?

Well, I got a couple emails yesterday from a guy that's developing that. Good news.

From a company right in Des Moines.

Within three months is what they're expecting to have these developed. Not actually all of them, but the ones that I pick out that say, hey, let's do these first.

Yeah. Seems like everything needs to process faster all the time. Everybody wants it faster.

Well, we want it faster, but we want to know what's being done.

Yeah, absolutely.

Does Kristen then get a report of all of the All of the trips that she sends to you for billing by patient name, date, how much you're billing out?

Yes.

You get all that?

Yeah. She gets that. We also check every PCR entered in her system. On our side, we check to make sure every one is accounted for. So there's nothing lost.

I get a reconciliation report.

She doesn't have to do the reconciliation, but she gets a report that says, here's how many you entered. Here's how many PCC entered. Here's the level of service of them. Here's all the detailed patient. You know, she gets all the detail as well. So we don't leave any of the anything. Some billing companies don't even ask for the no charge calls. And we have found that people categorize things as no charge, even though they can be billable events. So you can lose income. just by not getting all the trips, right? So that was an issue in the beginning. We wanted to make sure we had all the trips coming to us. Even if it's a canceled call, we want to count it. We want to make sure it's accounted for. So you as a governing body can know that every month we have somebody accounting for every single one and making sure the billable ones are getting billed and the no charge calls are entered accordingly so that on the practice analysis where...

It says it right there. Where? The first column, the first tickets.

Oh, here.

We received 2,994 tickets is what we call them, transports. 1,083 of them are not billable.

Right.

So as a board, I mean, there's costs built into that, even though those are non-charged tickets, right? So you kind of have to figure that all out. And if it's never reported to you, It's really hard to swallow that pill and have to pay for those costs, but you don't know what they're going to. Well, on the reports, you can see these are my no charge calls. And for the month of April, there was 91 times where your crew either responded or had a canceled call or refused patient, no patient found. There was 91 times that that happened. There's costs related to all of that. And those are built into our report to give to you as well. And so if nothing else, at least that's part of what we kind of learned today is just overview what some of these numbers really stand for so that you can kind of have that insight when you're making decisions as a board. So we like that for you to have that transparency because we know you guys have to obviously cover the costs and things like that for them to process or to be an agency, so. So absolutely, if there's additional reports or other questions you might have, if you elevate those to Kristen's, we will get answers for you, so.

Very good, thank you.

Yep, and we appreciate the opportunity to work with you, so thank you.

Thank you.

Yes, a comment.

Okay, so if we go down, we will be bringing back the drainage district next week, and then the first aid kit will come back when we have more information. Is there any other business to come before the board? Remember, ISAC is coming this week.

It's Wednesday. What is that exactly?

It's my understanding it's just part of their 99-county tour. They're not even going to be here that long, right? They're coming Wednesday at 1. They just want to visit. They'll kick off a meeting. Andrea will be here, the executive director, overview of ISAC and its programs, government relations, legal services, et cetera, about 30 minutes. And then at 1.30, they'll have an open discussion, usually about an hour for the whole thing. So it'll be done by 2. My question is, when are we going to do more drill down into the new legislation. In the past, they've done, when House File 718 came out, there was an in-depth session, and I'm just concerned that the only in-depth session they're gonna do is at their conference in August, where we'd have to pay significant dollars to attend one session. But I'll be asking Andrew about that.

So that's here?

Downstairs, in the big room. That's my understanding. Yeah, in the first floor training room from 1. It says 1 to 1.30, but I don't think it'll go beyond 2 from what I understand. And they've done quite a few. I think we're towards the tail end of the group. Is there anything else this week? Remember, next week we have home-based Iowa ceremony in Perry on the 2nd at the Elks. Was there anything else? Any other business?

Move to adjourn.

Second. Any discussion? All in favor say aye.

Aye.

Aye. Motion carried.