County reports large rise in ambulance billing charges and proposes switch from ESO to Fireworks after interface problems

Davidson County finance and EMS staff reported to commissioners on Nov. 6 that long‑term ambulance billing and a recent change in claims processing have increased gross charge volumes and collections, and that ongoing software interface problems are causing dropped calls and manual reconciliation work.

County staff explained that ambulance charges and collections have increased in recent years. Finance staff presented a historical trend of charges billed back to 2008 and said the county has collected roughly $111 million of about $142 million charged across the last 18 years (collection percentage varies by year). Staff noted that contracting directly with payers — rather than routing payments through patients — produced a material increase in recoverable revenue and that fiscal year 2024 and early 2025 collection activity suggests a continuing upward trend in receipts.

County billing staff said the current operational problem is an unreliable interface: ESO, the EMS call reporting software used by crews, intermittently fails to pass complete call records to TriTech, the county’s billing system. Billing staff reported instances where calls present in ESO did not import into TriTech, forcing IT and billing personnel to manually reconcile records; missed calls have potential revenue consequences because each missed billable dispatch can represent several hundred to thousands of dollars. Finance staff highlighted that even a modest number of missed calls can add up quickly at current charge levels.

To eliminate the interface and data‑loss problem, staff proposed a migration to the Fireworks product used by many local fire/EMS agencies and noted a successful sample test: a day’s calls were transferred correctly to TriTech in pilot testing. The Fireworks subscription would increase annual record‑management costs modestly (quoted at approximately $52,000–$55,000 per year), plus a one‑time implementation/training fee (quoted about $3,600). Staff proposed keeping ESO active during transition and phased cutover (March 1 target was suggested) to avoid losing in‑flight call records.

Commissioners asked for vendor references and a follow‑up report; finance staff said they would bring a formal procurement and contract amendment for board approval and asked for a 6‑month progress update after implementation. No procurement action was approved at the Nov. 6 meeting.

Separately, commissioners and staff discussed EMS operations: a draft change to part‑time EMS shift premium policy was described (payment eligibility moved to a pay‑period basis to simplify administration), and staff presented a proposal from a consultant group (North Carolina Fire Chief Consulting) to analyze schedules, CAD/CFS data and deployment models (the proposal included a capped cost estimate of about $23,000). Commissioners requested references and a copy of the consultant’s recent Forsyth County study before deciding on the engagement.