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Fire Agency EMS Fee's/Cost Recovery Questionnaire.
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1.
Agency name
2.
County agency located in
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)
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
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
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):
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)
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
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
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
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)
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)
13.
We transport or subcontract for transport services and participate in
PP IGT GEMT
Voluntary Rate Range IGT with County
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
<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
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.
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?
