Montgomery County committee hears EMS billing report and asks sheriff to draft collections policy

The Montgomery County Public Safety Committee on Tuesday heard a detailed briefing from EMR, the county’s ambulance billing contractor, on unpaid ambulance balances and possible next steps for collections. EMR told the committee that “about 180 days is about $300,000” remaining on the books and outlined how claims move from insurer follow‑up to patient invoicing and potential referral to a collection agency.

Committee members pressed EMR for details about the unpaid balance and collection practices. EMR explained the billing cycle, saying patient care reports are coded, charges applied and invoices sent; if an account is unpaid it receives a sequence of three invoices and a warning letter before referral. “They would get an invoice, every 15 days for a total of 3 invoices,” EMR said, and noted the company’s practice of tailoring thresholds: “we have clients that set a $300 limit that only folks that owe more than $300 go to collections.”

Why it matters: The balance represents revenue the county says has been through insurer follow‑up; committee members sought to balance debt recovery with concern for residents on fixed incomes or Medicare. Members repeatedly asked that any policy explicitly exclude low‑income and hardship cases and requested clearer reporting on the number of accounts underlying the dollar figure.

EMR said collection yields are modest — the company estimated collection rates at roughly 3%–5% on referred accounts — but that targeted referrals can recover “some of that meat that’s on the bone.” The firm also said hardship processes under Medicare rules allow governments to reduce or cancel certain charges and that collections can be paused or recalled if new insurance information emerges.

What the committee directed: Several legislators asked staff and the sheriff’s office to draft a county collections policy for committee review that would: exclude fixed‑income and hardship cases; define whether referral is per‑claim or per‑total accumulated debt; set monetary thresholds for referral; and identify approval steps before court action. A committee member summarized the next step as asking the sheriff’s office and county billing staff to “come up with a policy” and present it, possibly as a resolution.

Key quotes

“About 180 days is about $300,000,” EMR said, summarizing the firm’s year‑to‑date figure for older receivables.

“We have clients that set a $300 limit that only folks that owe more than $300 go to collections,” EMR said when describing an adjustable threshold option.

“They would get an invoice, every 15 days for a total of 3 invoices,” EMR said, describing the warning process before referral.

Next steps: EMR offered to deliver additional reports breaking the $300,000 into case counts and payer mix. Committee members asked the sheriff and staff to draft a collections policy reflecting the protections discussed; the policy is expected to return to committee as a proposed resolution before any formal change in collection practice.