Burke County to bring EMS billing in‑house, projects $6.9 million in collections

Burke County’s board heard from County Manager Brian Rogers that the county has moved EMS transport billing from a private contractor to an in‑house operation and expects a measurable increase in collections.

Rogers told commissioners the county projects $6,900,000 in EMS collections through June 30, 2025 — “$1,800,000 higher than last year” — and reported what he described as an increase in average revenue per bill from earlier in the fiscal year. The change comes after staff reviewed vendor fees and found collection rates had flattened under the previous contract with ESMC, which historically retained a percentage fee for billing services.

Rogers said in‑house billing will give the county additional collection tools it lacked under contract, including debt setoff and garnishment processes, and he described ongoing negotiations to change fixed hospital transport fees so they better reflect the county’s cost per unit. He also said the majority of transports are billed to Medicare or Medicaid and that higher collections will not fully cover EMS operating costs but will help narrow the gap for vehicle purchases and competitive staff pay.

“Historically we partnered with a company called ESMC…they kept a percentage, roughly 6 to 7% of net collections as their fee,” Rogers said. “Our projection at this point for collections through 06/30/2025 would be $6,900,000.”

The board did not take a separate vote on the billing transition during the pre‑agenda meeting; Rogers said the item will be presented again at the regular meeting with more details for commissioners and staff tracking as part of the budget process.

Next steps: staff will present finer budget projections and operational details at the regular meeting and continue renegotiation of hospital transport contract language to align unit costs with county expenses.