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Nelson County raises ambulance transport fees to 170% of Medicare allowable
Summary
The Board adopted Resolution R2025-05 to increase ambulance transport fees effective Jan. 1, 2025 (BLS $773, ALS1 $918, ALS2 $1,328, $16 per loaded mile) after staff presented Medicare-comparison options and collection estimates; the policy retains hardship waivers and volunteer write-offs.
The Nelson County Board of Supervisors voted unanimously Jan. 14 to raise ambulance transport fees, adopting Resolution R2025-05 to set rates at 170% of the Medicare allowable effective Jan. 1, 2025.
County Administrator Candice McGarry told the Board that the current rates had been unchanged since 2012 and presented comparisons to 150%, 170% and 200% of Medicare-allowable rural rates along with revenue projections tied to different collection rates. Staff recommended either 150% or 170% in the materials; after discussion the Board approved 170%.
What the new fees are: the resolution sets advanced life support (ALS) 1 at $918, ALS 2 at $1,328, basic life support (BLS) at $773, and mileage at $16 per loaded mile. McGarry said the county’s billing company (EMS/MC) retains 5.29% of receipts as its fee.
Financial context: staff showed January–December 2024 data with 1,348 trips and gross charges of about $1.2 million; after contract allowances and adjustments net charges were $912,037 and total payments received were $544,425, leaving an accounts-receivable balance of about $347,000 and a net collection rate of roughly 59.6% over the reporting period. Projections provided by the billing company estimated incremental annual revenue at various collection rates (e.g., at 170% of Medicare allowable, $48,000 at a 60% collection rate and $63,000 at 80%).
Protections and policy: McGarry emphasized that county policy prohibits denying necessary transport due to inability to pay, and a financial-hardship waiver (using 200% of federal poverty level guidelines) is available; volunteers or household members of volunteers receive an administrative write-off after insurance. The Board discussed revisiting rates regularly; supervisors said they preferred reviewing transport rates every year or two.
What comes next: staff will instruct the billing vendor to implement the new rates and track collection outcomes, and county finance staff will report results as part of regular budget monitoring.
