EMS billing is not a new or novel idea. In fact, approximately 85% of the EMS providers nationwide bill for patient transports. Some southern Ohio departments have been charging for EMS transports for nearly 10 years. Currently, all Warren County EMS Agencies charge to transport patients to the hospital.
On the surface, EMS billing seems like a money grab where Fire Departments are taking advantage of patients during a difficult and vulnerable time. However, the facts don’t support this conclusion. The information below is offered to give residents a better understanding of EMS billing.
How EMS Billing Works
While treating and/or transporting patients, EMS and hospital personnel gather patient information and, if possible, ask the patient to 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. They review 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.
What a Hamilton Township Fire District Resident Can Expect
Residents are considered persons who live in the Hamilton Township Fire Rescue service area, which includes unincorporated Hamilton Township, the Village of Maineville, and the parts of the Village of South Lebanon located within the Hamilton Township Fire District. Residents would not be billed for insurance co-pays or additional charges above the rate paid by their insurer. Residents may receive a letter requesting insurance information or verification, but they will not receive a bill even if they are uninsured.
What A Non-Resident Can Expect
Transport charges will be billed to a non-resident patient’s insurer in the same manner as a resident. However, non-residents will be billed for any unpaid balance not covered by the insurance carrier. If the non-resident is uninsured, they will be billed for the entire amount.
Ohio Revised Code Section for EMS Billing
505.84 Reasonable charges for use of ambulance or emergency medical services.
As used in this section, “authorized medicare reimbursement rate” means such rate established for the locality under Title XVIII of the “Social Security Act,” 49 Stat. 620 (1935), 42 U.S.C.A. 301 , as amended.
A board of township trustees may establish reasonable charges for the use of fire and rescue services, ambulance services, or emergency medical services. The board may establish different charges for township residents and nonresidents, and may, in its discretion, waive all or part of the charge for any resident. The charge for ambulance transportation for nonresidents shall be an amount not less than the authorized medicare reimbursement rate, except that, if prior to September 9, 1988, the board had different charges for residents and nonresidents and the charge for nonresidents was less than the authorized medicare reimbursement rate, the board may charge nonresidents less than the authorized medicare reimbursement rate.
Except as provided in section 505.441 of the Revised Code, charges collected under this section shall be kept in a separate fund designated as “the fire and rescue services, ambulance services, and emergency medical services fund,” and shall be appropriated and administered by the board. The fund shall be used for the payment of the costs of the management, maintenance, and operation of fire and rescue services, ambulance services, and emergency medical services in the township. If the fire and rescue services, ambulance services, and emergency medical services are discontinued in the township, any balance remaining in the fund shall be paid into the general fund of the township.
Amended by 129th General AssemblyFile No.27, HB 128, §1, eff. 9/23/2011.
Effective Date: 09-09-1988; 03-31-2005