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Committee hears ambulance report: collections lag, staffing improving; quarterly reporting proposed
Summary
Finance staff presented a detailed ambulance revenue-and-collections report and recommended switching to quarterly ambulance reporting. The committee heard that collections are seasonally delayed and staffing recently improved to allow three rigs.
Finance staff presented an Ambulance/EMS report that breaks ambulance revenue, gross charges, contra allowances and net collections and recommended moving ambulance reporting to a quarterly cadence paired with a standard EMSMC (EMS Management & Consultants) report.
The presenter explained that gross charges are reduced by contractual contra allowances (negotiated write-downs with insurers and Medicare/Medicaid), which amount to roughly one-third of billed charges. That means net charges and net collections need to be viewed on a multi-month basis; the presenter said ‘‘the closer the month is to current, the less likely we're going to have revenue because by the time it goes to insurance and everything, it's usually three months before you're seeing the money.’’
The report showed a modest profit in 2024 (about $53,000), which the committee assigned to ambulance fund balance under the proposed assignments. Finance staff recommended using a rolling multi-month collection view and tied payments to specific runs, which the presenter said allows clearer month-to-month reconciliation. The EMSMC report also included an aging analysis showing Medicare Advantage as a significant portion of outstanding receivables.
Committee members asked about transfers and third-party transport vendors; the presenter said transfers have risen but not dramatically and that communications with the local hospital have improved. On staffing, the report said the ambulance service had filled all but one paramedic position and upgraded three AMTs to paramedics after training and field training (FTO). The presenter said that improvement allows the service to work toward three rigs with two-person crews on each rig, improving transfer availability for hospitals and reducing reliance on deputies or outside transport contractors.
The committee agreed the ambulance material could be presented quarterly alongside the county's ambulance financial statements.
