Fire Agency EMS Fee's/Cost Recovery Questionnaire.

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1. Agency name

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2. County agency located in

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3. If your department transports or subcontracts for transport services:

We utilize fire department personnel/employees on our ambulances: (AO's, FF EMT's and/or FF paramedics, single role paramedics, suppression/non-suppression,etc )

We subcontract with a private ambulance company for transport services (BLS and/or ALS)

We utilize both fire department personnel/fire department ambulances and private ambulance personnel/ambulances

Other (please specify)

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4. If your agency transports/contracts for ambulance services directly/bills for services, answer the following: check all that apply

Ambulances are usually staffed with fire department EMT's who are also firefighters

Ambulances are usually staffed with fire department EMT's who are not firefighters

Ambulances are usually staffed with fire department paramedics who are firefighters

Ambulances are usually staffed with fire department paramedics who are not firefighters

We pay unit hours to a private company for BLS transport services and our firefighter paramedics are utilized for ALS level calls

APOD incidents affected the unit hours we paid to a private ambulance company in 2022

Other models

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5. Regarding EMS related fees:

My department currently bills hospitals for APOD

My department plans to bill hospitals for APOD in the next 1-12 months

Multiple or all fire agencies in our county are planning to bill hospitals for APOD in the next 1-12 months

My department plans to bill facilities for EMS related lift-assist/non-emergent fees in next 1-12 months)

My department currently bills facilities/entities for EMS related non-emergent services (lift assist, etc)

My department bills for first response fees ( for non-transported patients, or cost to respond)

My department bills for first response fee for transported patients

My department is a transport agency (or manages the contract/receives the transport revenue) and bills for BLS and/or ALS transport services

My department has a subscription service fee for residents ( fee covers response and/or transport fees)

My department has a subscription service fee for businesses (fee covers response and/or transport fees)

Other EMS related fees/services

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6. Regarding reimbursement by private ambulance companies:

Our fire personnel (EMT's and/or paramedics) are pulled onto private ambulances for transports without regular reimbursement from the private ambulance company.

When our fire personnel (EMT's or paramedics) are pulled onto private ambulance transports, we regularly receive a reimbursement for this service.

We are not reimbursed regularly for fire personnel utilized on transports by a private ambulance company and ambulance contract is part of EOA managed by County LEMSA

Other reimbursements or unreimbursed costs related to private ambulance companies (not equipment/supplies):

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7. Regarding EMS supplies/meds/equipment utilized by private ambulance companies (regardless of model -subcontracting , under the County, etc) on transported patients:

The private company uses their supplies only (they don't reimburse your dept for supplies or use yours or charge you for supplies)

They use our supplies and reimburse our agency for supplies used on a transport (can be individual items or flat fee per transport)

They restock from our dept EMS supplies

They charge our dept for supplies used on calls

Our EMS supply stock is used but no reimbursement is received from the private ambulance co

Our EMS supply stock is used and there is an inequity between reimbursement by private ambulance co and Dept EMS costs related to supplies used by private entity. Our dept loses.

Reimbursements for supplies/equipment/meds used on transported patients by a private entity fully covers the actual costs to our department for those supplies/equipment/meds used on the transport

There is a supplies reimbursement inequity (fire dept has a loss) and the private ambulance company EOA/contract is managed by County LEMSA.

Other (please specify)

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8. If billing for APOD (or planning to), what are/would be the fee's charged per incident, if on the wall time/offload delay lasted 1 hour (even if billed in 15 min increments)

<$100/hr

$100-200/hr

$200-300/hr

$300-400/Hr

$400-500/hr

$600+/hr

Billed in 15 min increments starting at 20 min

Billed in 15 min increments starting at 30 min

Billed in 15 min increments starting at 60 min

Billing rate increases after specific time - for example after 1 hour, increment cost increases

Billing varies based on additional factors besides just time at the hospital (BLS/ALS, number of patients responsible for, etc)

Don't know amount yet

Other Apod billing fees/increments

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9. If billing facilities for lift assists, answer the following

Facility is billed for every incident

Facility is billed after certain number of incidents per day/week/month (describe below)

fee amount <$100 per incident

fee amount $100-200 per incident

Fee is based on additional factors (time spent at facility, # of personnel assisting, etc)

Dont know yet

Briefly explain program: billing scale/ amount billed per incident, etc

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10. Subscription fees ( benefit offered to residents/ businesses to reduce or fully cover response and/or transport costs)

Billed one time annually

Billed monthly or bi-monthly

Is for residents/their household

Offered to businesses

Covers first response fees

Covers transport fees

Program regularly sustains losses (write-offs exceed revenue)

Revenue from program regularly exceeds write-offs

Fee is <$50 annually

Fee is $50-59 annually

Fee is $60-69 annually

Fee is $70-79 annually

Fee is $80-89 annually

Fee is $90-99 annually

Fee is $100-120 annually

Fee is $121-150 annually

Fee is over $150 annually

Business fee is based on base rate and # of employees

Briefly describe fee structure for subscription fees if not captured above

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11. If your agency transports/contracts for ambulance services directly/bills for services, answer the following: These rates do not include supplies/medications/equipment use. check all that apply

Our BLS base rate averages $1000-1500

Our BLS base rate averages $1500-2000

Our BLS base rate averages $2000-2500

Our BLS base rate averages $2500-3000

Our BLS base rate averages over $3000 (put info response)

Our ALS/AlS 2 base rate averages $1000-1500

Our ALSALS2 base rate averages $1500-2000

Our ALS/ALS2 base rate averages $2000-2500

Our ALS/ALS2 base rate averages $2500-3000

Our ALSALS2base rate averages $3000-4000

Our ALS/ALS 2 base rate averages $4000+

We itemize bill for all medications given given on the incident

We itemize bill for all supplies/procedures/equipment used on the incident

Our costs for medications/supplies/procedures/equipment is rolled into the BLS or ALS base rate

Our transports rate (BLS or ALS) are same for resident/ non-resident

Our transport rate is lower for residents

Other (please specify)

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12. If your agency charges a first response (non-transport fee) answer the following:

Non transport fee is billed differently for residents vs non residents

Non transport fee is billed same for residents vs non residents

First Response fee is also billed with the transport fee

Fee is <$300 per patient

Fee is $300-399 per patient

Fee is $400-499 per patient

Fee is $500-599 per patient

Fee is $600+ per patient

Our non-transport/First Response fee is same rate for residents and non residents

Our non-transport /\First Response fee is lower for residents.

We have a separate/higher non-transport fee for CPR , left on scene/coroner situations

Other (please specify)

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13. We transport or subcontract for transport services and participate in

PP IGT GEMT

Voluntary Rate Range IGT with County

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14. Other EMS related revenue/cost recovery generating fee's, programs, etc

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15. Fee/% of recovered costs paid to ambulance billing company for services or billing done in house

<3%

3-3.5%

3.51%-3.75%

3.76%-4.25%

4.26%-5%

5.1%-6%

6.1 %-7%

Flat fee

Amb Billing done in house - no fee paid to outside entity

Other fee paid to billing company not in survey

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16. Name of company(ies) assisting with revenue recovery or EMS programs - for example: IGT, Amb Billing, CMS report etc (not collections)

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17. Our department is reimbursed in some compacity for community services provided by fire department personnel: community paramedic services, nurse practioner services, behavioral health unit, etc.

Yes, in some capacity our services are reimbursed

Services provided but no reimbursement at this time

If receiving some sort of reimbursement, what is the program name? Who reimburses you?

Fire Agency EMS Fee's/Cost Recovery Questionnaire.

Question Title

* 1. Agency name

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* 2. County agency located in

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* 3. If your department transports or subcontracts for transport services:

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* 4. If your agency transports/contracts for ambulance services directly/bills for services, answer the following: check all that apply

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* 5. Regarding EMS related fees:

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* 6. Regarding reimbursement by private ambulance companies:

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* 7. Regarding EMS supplies/meds/equipment utilized by private ambulance companies (regardless of model -subcontracting , under the County, etc) on transported patients:

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* 8. If billing for APOD (or planning to), what are/would be the fee's charged per incident, if on the wall time/offload delay lasted 1 hour (even if billed in 15 min increments)

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* 9. If billing facilities for lift assists, answer the following

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* 10. Subscription fees ( benefit offered to residents/ businesses to reduce or fully cover response and/or transport costs)

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* 11. If your agency transports/contracts for ambulance services directly/bills for services, answer the following: These rates do not include supplies/medications/equipment use. check all that apply

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* 12. If your agency charges a first response (non-transport fee) answer the following:

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* 13. We transport or subcontract for transport services and participate in

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* 14. Other EMS related revenue/cost recovery generating fee's, programs, etc

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* 15. Fee/% of recovered costs paid to ambulance billing company for services or billing done in house

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* 16. Name of company(ies) assisting with revenue recovery or EMS programs - for example: IGT, Amb Billing, CMS report etc (not collections)

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* 17. Our department is reimbursed in some compacity for community services provided by fire department personnel: community paramedic services, nurse practioner services, behavioral health unit, etc.

1. Agency name

2. County agency located in

3. If your department transports or subcontracts for transport services:

4. If your agency transports/contracts for ambulance services directly/bills for services, answer the following: check all that apply

5. Regarding EMS related fees:

6. Regarding reimbursement by private ambulance companies:

7. Regarding EMS supplies/meds/equipment utilized by private ambulance companies (regardless of model -subcontracting , under the County, etc) on transported patients:

8. If billing for APOD (or planning to), what are/would be the fee's charged per incident, if on the wall time/offload delay lasted 1 hour (even if billed in 15 min increments)

9. If billing facilities for lift assists, answer the following

10. Subscription fees ( benefit offered to residents/ businesses to reduce or fully cover response and/or transport costs)

11. If your agency transports/contracts for ambulance services directly/bills for services, answer the following: These rates do not include supplies/medications/equipment use. check all that apply

12. If your agency charges a first response (non-transport fee) answer the following:

13. We transport or subcontract for transport services and participate in

14. Other EMS related revenue/cost recovery generating fee's, programs, etc

15. Fee/% of recovered costs paid to ambulance billing company for services or billing done in house

16. Name of company(ies) assisting with revenue recovery or EMS programs - for example: IGT, Amb Billing, CMS report etc (not collections)

17. Our department is reimbursed in some compacity for community services provided by fire department personnel: community paramedic services, nurse practioner services, behavioral health unit, etc.