Jackson County adopts consultant‑recommended ambulance fee schedule, board cites budget strain

Jackson County commissioners voted to adopt a consultant‑recommended ambulance fee schedule that raises billed charges for ambulance transport to 300% of the Medicare allowable rate for rural and super‑rural ZIP codes, a change staff says will improve collections and help narrow an existing service funding gap.

The board approved the change after a lengthy discussion that centered on collection rates, payer mix and potential effects on uninsured or underinsured residents. Chief Brunner, the county’s fire and rescue chief, told commissioners the county currently collects roughly 70–72% of billed ambulance revenue and that the consultant identified 300% as a ‘sweet spot’ balancing higher reimbursement against write‑offs. “Right now, we run about a 70 to 72% collection rate,” Brunner said. He added the Department of Health Bureau of EMS is piloting the medication‑management software and that private insurers in rural areas will often pay a multiplier above Medicare.

Staff provided an estimate of revenue impact tied to the new schedule: last year’s estimated returned revenue for ambulance transport was $3,670,000 and, using the current payer mix and run volume, the new rates were estimated to bring an additional roughly $736,000 in recoverable revenue. Commissioners noted that Medicaid patients cannot be balance‑billed and that uninsured patients’ balances are typically written off; Brunner said unpaid balances are ultimately absorbed by the county. “If the patient is uninsured, then the patient is billed for the amount,” he said; unpaid balances are subject to collection processes and, where appropriate, write‑offs.

Several commissioners pressed staff for scenarios illustrating out‑of‑pocket impacts on typical insured residents; the chief answered that out‑of‑pocket responsibility depends on the individual’s plan, deductible status and whether they have supplemental coverage. He said commercial insurers often reimburse at up to 300% (and up to 350% is allowable in some rural classifications), and the county is not required to adopt the maximum.

After debate about potential hardship for a small number of self‑pay patients, a motion was offered and seconded to adopt the consultant’s recommended 300% fee schedule; the board voted to approve the change. The motion authorized adoption of the new ambulance fee schedule and empowered the chair to sign the resulting fee schedule documentation.

Next steps: staff will implement the new fee schedule in the county’s billing system and continue to monitor collection performance and payer behavior; commissioners indicated they could revisit the schedule if needed.

Sources: discussion and votes during the Jackson County Board of Commissioners meeting.