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Town hears ambulance billing report; vendor says Gray collects about 88% of billed charges, suggests 5% annual rate increase
Summary
Medical Reimbursement Services told the Gray council the town’s ambulance collections average roughly 85–90% and recommended adding insurer contracts and a 5% annual rate increase; councilors asked staff to place a 5% rate increase proposal on a future agenda for formal consideration.
Sean McFersonen of Medical Reimbursement Services told the Gray Town Council on Feb. 3 that the town’s ambulance billing shows a collection rate of roughly 85–90% — “for every dollar we put out, we get 88 cents back,” he said — and that unpaid bills are primarily driven by uninsured patients and insurer‑allowed write‑offs from Medicare and Medicaid.
McFersonen presented the company’s journal summary of charges and payments from July 1 through Jan. 31, reviewed accounts‑receivable and adjustments, and described the billing workflow: coding, electronic submission to insurers in about 95% of cases, and third‑party searches to locate insurance when records are incomplete. He said Medicare constitutes about half of transports in Gray, Medicaid roughly 20% and private insurance about 22–23%, with self‑pay near 6%.
During a wide-ranging question‑and‑answer period, councilors pressed him on where the town is “bleeding” revenue. McFersonen said unpaid bills for uninsured patients and insurer rules that set allowed amounts are the principal causes of write‑offs; he also described hardship and payment‑plan practices and said the company generally moves accounts toward collections after several notices.
On rates, McFersonen explained how participation with private insurers affects reimbursement and described statutory and industry ceilings: insurers and Maine EMS encourage participation by allowing up to about 200% of Medicare for participating providers (180% otherwise). He said Gray has not increased its rates since 2019 and presented a state allowance that generally permits about a 5% annual increase. Council discussion moved toward a 5% increase; members asked staff to place a rate‑increase proposal on a future agenda so the council can act formally.
The presentation concluded with council members asking staff for written follow‑up on year‑to‑date shortfalls and comparables from neighboring services. McFersonen offered to gather additional insurer participation options and to identify potential firms for contract review.
What’s next: Councilors asked staff to add a 5% ambulance rate increase proposal to a future agenda for formal consideration and potential ordinance/fee‑schedule action.
