Burke County moves EMS billing in-house, projects higher collections

Burke County officials said the county has transitioned prehospital ambulance billing from an outside vendor to an in‑house operation and is projecting higher collections in the 2024–25 fiscal year.

County Manager Brian (county manager) told the Board of Commissioners at the Jan. 7 pre‑agenda meeting that the county historically contracted with Emergency Services Management Company (ESMC) and paid a fee (described in the packet as roughly 6 to 7 percent of net collections). He said the county evaluated doing billing in house after seeing flat revenue and a perceived noncompetitive collection percentage with the vendor.

“Today, I'd specifically like to, highlight EMS billing,” Brian said, describing a county review of peer counties that handle billing internally and the decision to bring the function in house. He said those peers showed higher revenue per transport. Brian gave a fiscal projection and operational rationale but also cautioned the county still does not expect billing to cover the full cost of EMS operations.

The manager said the county’s projection for total EMS collections for the year ending June 30, 2025, is $6,900,000 and that figure is higher than recent years. He said at the current projection the county expects about $1,800,000 more than last year and a substantial increase over the year before. He also said the county has seen an increase in average revenue per bill compared with prior levels.

Brian described additional in‑house recovery tools the county can now use: debt set‑off (a statewide system that can offset state refund payments for amounts owed to the county) and wage garnishments where applicable. He also said bringing billing in‑house will allow more control over negotiations with hospitals for interfacility transports and permit the county to pursue cost‑per‑unit reimbursement rather than fixed fees in some contracts.

Brian noted about 65 to 70 percent of transport bills are to Medicare or Medicaid and that changes to contract structure, collection practices and negotiated interfacility rates are intended to close the gap between EMS operating costs and revenue. He described other related reengineering measures—cardboard compaction at solid‑waste sites, in‑house MSW transport, centralized fleet replacement planning and IT efficiencies—that are intended to free resources across the county budget.

Board members had no additional questions at the pre‑agenda meeting. The EMS billing information will be presented in greater detail at the county’s regular meeting, according to the manager.

The county did not take a formal vote on policy changes at the pre‑agenda meeting; the presentation was described as an update and the item was left on the regular meeting agenda for further review.

Ending: County officials plan to present more detailed financials and implementation steps at the next regular meeting; the manager encouraged commissioners to review the audit and billing materials provided in their packets and to direct any questions to staff in advance.