Carmel committee reviews ambulance capital fund rates, billing and collection practices

CARMEL, Ind. — The Finance, Utilities and Rules Committee of the Carmel Common Council on March 11 reviewed proposed changes tied to ordinance D-27-67-25 and spent the bulk of the meeting analyzing the ambulance capital fund’s fee schedule, billing and collection practices.

The discussion centered on how the city sets ambulance charges, who pays (resident vs. nonresident), how much the city is able to collect after Medicare and Medicaid reimbursements and write-offs, and whether the ambulance fund should continue to pay for capital equipment and lease debt. Joel Thacker, fire chief of the Carmel Fire Department, presented comparisons of Carmel’s 2025 rates with 2024 rates from neighboring departments and described operational and billing practices.

Why it matters: The ambulance capital fund is a self-funded revenue source tied to ambulance billing that Carmel uses for EMS supplies, equipment and some capital outlays. Committee members said they want to preserve access to emergency care for Carmel residents while making sure the fund is managed sustainably and that fees and collection practices reflect current billing realities (Medicare/Medicaid limits, third‑party collections and hospital interactions).

Thacker told the committee Carmel’s billed resident rate for a BLS 9-1-1 transport in 2025 is $656 and the nonresident rate is $856; he said those figures put Carmel “very low, compared to other rates around.” He said Carmel logged about 6,000 medical calls in 2024, of which roughly 5,000 were transports. Based on the department’s cost model, he said an average cost per transport is about $845.25 using the 5,000-transport figure.

Chief Thacker also highlighted a recurring operational strain: about 1,100 of last year’s calls were lift assists (falls) that often involve care facilities. He said some communities bill the care facility for those calls rather than billing the patient and suggested the city consider a similar approach so those routine lift-assist responses do not consume disproportionate EMS resources.

“That’s something that we should look at,” Thacker said of lift-assist billing for care facilities. He and EMS leadership also described a treatment-no-transport policy that allows billing for time and equipment when crews treat patients who decline transport.

Zach Jackson, the city’s controller/CFO, described the ambulance capital fund as primarily a capital fund (he used the phrase “ambulance capital fund”) that historically covered capital outlays and some lease payments for fire apparatus. Jackson said the city’s 2020 spending exceeded collections but that in recent years the fund has stabilized. He and the committee discussed a refinance of capital lease debt that freed about $500,000 a year but left a structural gap the city has been addressing.

Benjamin Leggs, corporation counsel, reviewed legal constraints. He cited Indiana Code 16-31-5 as the statutory authority for municipal EMS fees and said the statute permits “reasonable fees” and that billing is governed by federal and state reimbursement rules, billing codes and HIPAA obligations. Leggs summarized the city’s billing and collections process: hospital-provided insurance information is often used to run claims; billing uses a 30/60/90‑day notice process; unpaid balances are referred to the law department; and the city can pursue judgments or use the state refund interception program (referred to locally as TREX) to collect debts. He said the fire department does not report medical collections on individuals’ credit reports and that attorney fees incurred in collection are charged and (when collected) are remitted to the General Fund.

Committee members pressed for more detailed data: call counts by code (BLS vs. ALS), number and dollar totals of transports by resident status, collection rates, payer mix (Medicare/Medicaid/commercial/self-pay), write‑off totals and the mechanics of how Medicaid/Medicare caps limit recoverable revenue. Thacker and Jackson said staff will prepare a follow-up packet with that breakdown and cost estimates per transport, and billing manager Michelle Harrington (identified in the discussion) explained the department does not hold contracts with insurers because negotiated-contract arrangements can bar recovery from patients for amounts above the contracted insurer payment.

The committee also discussed the fund’s current uses. Jackson and council members said many other jurisdictions rely on ambulance funds to cover apparatus and capital costs; Carmel uses its ambulance fund for capital lease payments and EMS supplies and is considering whether some purchases should shift back to the General Fund supply budget. Jackson said an annual Medicaid-related settlement typically yields a few hundred thousand dollars and has historically been deposited to the General Fund; he suggested the committee consider whether those receipts should instead be credited to the ambulance fund.

Discussion items and next steps: Committee members asked staff to provide - a breakout of 2024 calls by call type (BLS/ALS/ALS2, treatment-no-transport, lift assists), including counts and revenue billed and collected; - a payer-mix and write-off analysis for 2024 showing Medicare, Medicaid and other write-off categories and collection rates compared to peer departments; - a review of resident versus nonresident definitions in the ordinance and a recommendation on whether the current resident definition (which treats anyone living anywhere in Indiana as a resident for charging purposes) should be narrowed to in-city addresses; - options to bill care facilities for lift assists and legal constraints for doing so; and - recommended ordinance language for the committee’s consideration (COLA provisions, fee schedule structure and any one-time adjustments).

No ordinance vote was taken in committee. Councilors and staff agreed the chief and billing staff should return with data and recommended ordinance edits for further committee review. The meeting record shows the committee adjourned after the city-code discussion.

Ending note: Committee members said they want changes that keep emergency care accessible while ensuring the ambulance fund remains a viable capital resource for EMS equipment and apparatus. Staff were asked to return with the requested data and draft ordinance language before the item goes to the full council.