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Rowlett fire chief explains ambulance billing, payer mix and options to adjust nonresident fees
Summary
Chief Gauthier reviewed Rowlett's ambulance billing practices, noting the city has not updated fees since 2014, uses Emergicon for third‑party collections (about 45% collection rate), and that Medicare/Medicaid payment caps limit recoverable revenue; council asked for analysis of raising nonresident or ancillary fees within regulatory caps.
Chief Gauthier presented a review of the city’s ambulance billing procedures and fee schedule, which the chief said has remained largely unchanged since 2014. He described the city’s billing categories (BLS, ALS‑1, ALS‑2), ancillary charges such as oxygen and mileage, and said the third‑party vendor Emergicon has produced a collection rate near 45 percent — above industry norms the chief cited.
The chief said the city’s payer mix is heavily weighted toward Medicare and Medicaid (roughly 63 percent), which are subject to statutory or regulatory payment caps that limit the amount the city may collect from those payers; any balance above those caps would become private‑pay responsibility and collection rates for private pay are historically lower. The city billed roughly $3.5 million last year and collected just under $1.8 million, the chief said, noting increases in Medicare/Medicaid caps have improved collections slightly.
Council members asked whether to raise fees, particularly for nonresidents, and whether ancillary charges (mileage, oxygen) could be increased without running afoul of payer caps. The chief said higher charges may be possible but that increased rates do not translate linearly into collections because of caps. Council directed the chief to return with a recommendation focused on nonresident fees and possible adjustments to ancillary charges, and to continue helping residents who raise billing complaints to work with the vendor.
No formal rate change was adopted during the work session.
