Consultants presented a multi-year analysis of Hallandale Beach’s emergency medical services (EMS) revenue and collection practices at the City Commission meeting on Jan. 8, saying the city faces a growing shortfall unless billing, documentation and policy changes are made.

Cassandra Lee of Emergency Services Consulting International (ESCI) told the commission that most billable incidents are advanced life support (ALS) emergencies — “about 3,000 incidents per year” — while basic life support (BLS) transports are fewer than 1,000 annually. She summarized the city’s payer mix as heavily weighted to Medicare and noted that Medicare pays allowed rates limited by federal rules.

Lee said gross ALS charges average about $2.6 million annually and that Medicare accounted for nearly half of initial charges in the period reviewed. Patient self-pay charges totaled roughly $950,000 and adjustments and write-offs affected net revenue; ESCI reported roughly $1.1 million in adjustments largely tied to ALS claims. The consultants recommended steps including: reviewing ALS claims denials; standardizing patient-care narratives used for billing; revising the resident transport-fee waiver policy; contracting with specialized insurance-collections firms; and evaluating long-term revenue options such as a dedicated millage or special assessment.

City Manager Dr. Earl said the study will be foundational for upcoming budget discussions, and that, “that deficit will grow by approximately $4,000,000 over the next 5 years” if no changes are made; he added the single-year increase from FY26 to FY27 is roughly $800,000. The consultants also noted the Broward Sheriff’s Office (BSO) provides fire rescue and EMS under contract and that some operational and data elements will require working closely with BSO and the city’s billing contractor.

Commissioners pressed for additional detail. Commissioner Butler said the city appears to be “creating a collections issue” by billing high gross charges when realized payments are a fraction of those amounts; Butler noted the city collects about 37% of ALS charges and 53% of BLS charges. ESCI explained some shortfalls stem from insurer allowable rates, narrative/documentation mismatches that lead to denials, and historical COVID-19 fund rules that temporarily changed billing practice.

Consultants flagged several follow-up tasks: obtain more granular denials reports from the billing vendor; analyze frequency of repeated transports by specific residents; clarify use and limits of the city’s transport-fee waiver; and explore community paramedic programs and other alternatives to repeated transports. ESCI also described AHCA/PEMT reporting and a federal CMS data survey that can help apportion EMS costs but noted the data collection is resource intensive.

There was no vote attached to the presentation; commissioners and staff said the findings will inform budget workshops and a future discussion about the fire assessment methodology and potential revenue measures.