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EMS Billing
Orange Township Fire DepartmentOTFD Logo TN.jpg

Orange Township will be moving in the direction of billing for EMS services to take effect March 2017. Your OT representatives have been working in collaboration with Delaware County and many other Townships to put this program into place.

Most of your questions should be answered with the information provided; however, you are more than welcome to contact Fire Chief, Matt Noble at 740-657-8290 should you have more questions.

EMS Billing Facts

History

EMS transport billing started in early 1990’s due to funding challenges of local government.

Most communities have engaged in billing insurance providers for EMS transport services to lessen the burden on the taxpayer.
 
EMS billing is not a new or novel idea.  Approximately 85% of the EMS providers nationwide bill for patient transports.  Delaware County is the only county that I am aware of in Central Ohio that presently does not bill.

ORC Section 3901.71 and Chapter 1751.01 outline “Basic Health Care Services” that shall be incorporated in all Ohio health insurance policies.

Ohio law requires all health insurance companies to set aside funds specifically for EMS transport.  Typically 1-2% of the premium.  This premium is paid by the customer whether billed for transport or not.  When these funds aren’t used for EMS transport billing they can be converted to profits for their shareholders.

Soft Billing .vs. Hard Billing

Soft Billing
  • Soft billing is charging the insurance company and accepting the amount they pay for the service as payment in full.  Any balance due, after insurance payment is written off.
  • Orange Township patients would not be billed for insurance co-pays, deductibles or additional charges above the rate paid by their insurer.  Patients may receive an Explanation of Benefits (EOB) from their insurance carrier and may receive a letter requesting insurance information or verification, but they will not receive a bill even if they are uninsured.
  • Non-Orange Township patients will be billed for any amount not covered by the insurance provider.  By law the billing company must make a reasonable attempt to collect the amount not covered by the insurance provider.  So the billing company will send three letters requesting the unpaid balance.  After three attempts the unpaid balance is written off.

Hard Billing
  • Hard Billing is charging the insurance in the same manner as Soft billing; however, when hard billing, patients will be billed for any unpaid balance not covered by the insurance carrier.  If the patient is uninsured, they will be billed for the entire amount.  After the three attempts for payment the unpaid balance may go to collections.

Billing Options
  • Soft Bill all patients – Option Selected for Orange Township
  • Hard Bill all patients
  • Soft Bill residents and Hard Bill non-residents

How it Works
  • While treating and/or transporting patients, EMS and hospital personnel gather patient information and have the patient sign a form authorizing disclosure of specific medical information protected by HIPAA privacy rules.
  • This information is electronically submitted to a third party billing service. 
  • The billing service reviews the report to determine the appropriate fee for the transportation services provided. 
  • Once the fee is determined, a claim is submitted to the patient's private or government insurance carrier.

How Much Does it Cost?
  • The cost of the transport would depend on the type of the service provided and the distance to the medical facility.  For example, the charge for Basic Life Support (BLS) transports will be less than the charge for Advanced Life Support (ALS) transports.  Our rates would be based on the reasonable and customary Medicare rates for our region and would be comparable to the rates of other departments in Central Ohio.

Recommendation
  • Mileage - $14.50 per loaded mile
  • Basic Life Support (non-life threatening) - $685.00
  • Advanced Life Support (life threatening) - $810.00
  • Advanced Life Support with multiple drug interventions - $1,175.00

How Can Revenue be Used?
  • By statute, revenue raised by charging for EMS transports would be used for expenses associated with the “management, maintenance, and operation of the Township’s Fire and EMS services” that are currently being paid by levied tax revenue in the Fire Fund.
  • In Orange Township, this new source of revenue would be used for the purchase of EMS related items (i.e. Vehicles, Equipment, Future Stations) to assist in stretching Fire Levy Tax dollars further in the Township.

FAQ’s

Will I be denied service if I am unable to pay to be transported to a medical facility?
No.  No one will be denied emergency medical service or transport for any reason.  The medical treatment that a patient receives will not be changed in any way by an EMS billing program.

Will my insurance premiums go up if we start EMS transport billing?
No.  Ohio law requires the premium to be collected whether utilized or not.

When will I be asked to pay for transportation to the hospital?
Sometime after your hospital visit, your insurance carrier will be billed for the transport.  When your insurance carrier or Medicare pays the transport charges, you will receive an “Explanation of Benefits” form to notify you that the charges have been paid.  That will be the end of the transaction for residents in Orange Township.  In some cases, the third party billing service may not have the name of your insurer.  In those cases, you may receive a letter asking you to provide this information.  If you are a resident, you will NOT receive nor will you be expected to pay the bill yourself.  Charges are assessed only if the patient is transported to a medical facility.  If a patient receives medical attention, but is not transported, there is no charge for the service.


1816 - Orange Township
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