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Burke County moves EMS billing in-house, projects $6.9 million in collections through June
Summary
County manager outlined a shift from an outside billing contractor to in-house EMS collections, reporting higher revenue per bill and a projected $6.9 million in collections for fiscal year 2024–25; implementation includes contract renegotiations with hospitals and use of debt setoff tools.
County Manager (name not specified) told the Burke County Board of Commissioners on Jan. 7 that the county has transitioned EMS transport billing from a private vendor to an in-house operation and is projecting $6,900,000 in collections through June 30, 2025.
The county manager said the shift followed an internal review showing “flattened” revenues under the prior contractor and a belief that in-house billing could increase collections and control costs. He said the county historically shared about 6–7% of net collections with the vendor and believed collection performance could improve by bringing the service under county control.
The manager described the change as part of a larger “reengineering” effort to reallocate existing resources toward the board’s strategic priorities via cost avoidance, revenue maximization and efficiency gains. He said preliminary results show the county’s average revenue per EMS bill rose to about $370 from roughly $275–$280 in prior years, and that projected collections are approximately $1.8 million higher than last year and $1.4 million higher than the year before.
He said roughly 65–70% of EMS bills go to Medicare or Medicaid, with a smaller share to private pay, and that higher collection rates nonetheless do not fully cover the total cost of EMS operations but do narrow the gap. The county manager also described negotiations to change fixed-fee arrangements with local hospitals—where transfers from one hospital campus to another have been billed at a flat fee—to contracts that reflect cost per unit, which he expects will better recoup county costs for interfacility transport.
Other steps cited to strengthen collections include use of statewide debt setoff and wage garnishments, renegotiation of certain hospital contracts, and pursuing higher collections on interfacility and out-of-county transfers. The manager said the county audited comparable programs in other North Carolina counties and noted that some counties that bill in-house show higher revenue per transport.
The manager emphasized that the change provides “authoritative billings” options—such as debt setoff—and greater operational control, and asked commissioners to direct questions to staff during the regular meeting for more detail. No formal action or vote on the billing transition was recorded at the pre‑agenda session; it remained listed for the regular meeting for a fuller presentation.
The county manager said staff will report back during the formal budget process and at an upcoming March work session with performance updates and projections.
Ending: County staff will present a detailed report and financial projections at the regular commission meeting; commissioners asked no substantive questions at the pre‑agenda discussion.
