G-1223 - 05/23/2023 - FIRE DEPT. EMS SERVICES - Ordinances Supporting DocumentsVt LLAC I ot'
ITEM 8.A.11
BOARD OF TRUSTEES MEETING
SAMUEL E. DEAN BOARD ROOM
BUTLER GOVERNMENT CENTER
12OO OAK BROOK ROAD
OAK BROOK, ILLINOIS
630-368-5000
Onrc BRg.gK .a-./dtot ZA&,
AGENDA ITEM
Regular Board of Trustees Meeting
of
May 23,2023
SIIBJECT: Ambulance Billing Rates
FROM: Kevin Fleege, Fire Chief /f*
BL'DGET SOLRCEiBt'DGET I\lP.\CT: 202-1 General Fund
RECOMMENDED MOTION: I move that the Village Board approve Ordinance
G-1223, an ordinance amending Section 3-2-5 of Title 3 ofthe Village Code ofthe Village
of Oak Brook relative to fees for use of Emergency Medical Services provided by the Oak
Brook Fire Department; Ambulance Billing Rates.
Background/Historr :
The fire department's current fee stn:cture for Emergency Medical Services has been in
place since revised and adopted in July of20l8. The fee structure is as follows:
NON RESIDENT RESIDENT
ALS I ALS 2 BLS MILEAGE ALS I ALS 2 BLS MILEAGE
s 1,800 s I ,800 $ I ,800 s 19.00 $ I ,600 s I ,600 s l ,600 s 19.00
Under the current billing model, all patients are sent to collections for unpaid balances,
regardless of residency status.
In November 2019 and by resolution, the Oak Brook Fire Department began participating
in the Federal Govemment's Ground Emergency Medical Transportation (GEMT)
program. This program provides supplemental pa).rnent to the Village to cover the funding
gap between a provider's actual cost per ambulance transport ofa Medicaid patient and the
allowable amount received from Medicaid and any other sources of reimbursement. In
2023,Lhe fire department's approved GEMT rates are as follows:
REC BOT 052323 Agenda Item 8.A.1I Ord. G'1223. Ambulance BillinS Ratcs Pase I
a;. s
BLS ALS
$7,37r.40 s7,269.83
Since the fire department's last emergency medical service fee rate increase in 2018, many
area departments have moved to singular GEMT billing for all patients. Neighboring
departments including Clarendon Hills, Hinsdale, Westmont and York Center all follow
this model. The chart belovv shows the ambulance billing rates for neighboring agencies:
MUNICIPALITY BLS ALS-1 ALS-2 MILEAGE
Clarendon Hills $5,468.29 $5,926.28 $5,926.28 $25.00
Elmhurst (NR)$2,324.40 s3,486.60 $3,873.98 s30.00
Elmhurst (RES)$ 1,937.00 $2,905.49 $3,292.73 s26.00
Hinsdale $2,725.06 $3,378.15 $3,378.15 s25.00
Westmont s2,300.00 s2,300.00 $2,300.00 $ 18.00
York Center $2,795.06 $2,795.06 $2,795.06 s20.00
Although Oak Brook could go follow this model, our average GEMT rates fall outside of
what is considered "usual and customary" for those privately insured. The current usual
and customary coverage range for ambulance transports paid by private insurance
companies is between $2,500 and $3,000. Moreover, with 50% of the GEMT rate collected
fiom the Federal Government, paid to the state, the fire department's average realized
transport rate is $3,660.31.
Given neighboring fire department average billing rates of$3,409 and $26 per mile, Oak
Brook's GEMT rate as well as usual and customary private insuance payments,
staff is recommending a singular ambulance-billing rate of $3,000 for emergency medical
sewices rendered and $25.00 per mile for fansport. Additionally, for Village of
Oak Brook residents, staff is recommending no balance billing. After insurance
payment is collected, Oak Brook residents will not be billed or sent to collections for any
unpaid balances.
Based on an emergency medical services billing rate of $3,000, the following is a
consen,ative projection of increased revenues from private insurance and self-pay
tran orts
Village of Oak Brook Rate Analysis
Based on 2022 data
Increrse Charge
Amount Total Calls Gross Charges
Average
Collection
Percentage Potential Rev
RES
Insurance $1,400.00 46 s64,400.00 50%$32,200.00
$0.00Patient$1,400.00 2:'$35,000.00 0./.
$32,200.00Total
REG BOT 052323 Agenda Item 8.A.11 Ord. G'1223, Ambulance Billins Rates Page 2
Increase Charge
Amount Total Calls Gross Charges
.A.verage
Collectioo
Percenlage Potential Rev
.\-oN
lnsurance $1,200.00 232 $278,400.00 s0%$139,200.00
Patient $1,200.00 98 sl 17.600.00 4%$4,704.00
Toral $ 143,904.00
Estimated
Additional
Revenue Sl76-10i1.00
In addition, the Village would also receive an additional $7 per mile per transport. Using
an average distance per trip of4 miles from call location to the hospital and applying it to
401 furivate insurance and self-pay) transports, the Village could conservatively realize an
additional $5,614 - $8,421 in additional mileage fees.
Recommendation:
Staff recommends the approval of the motion to amend the Fire Departmental Fee
structures regarding Emergency Medical Services for those who receive treatment and
transport to a single service fee of $3,000 and a per mile fee of$25.00. Additionally,
staff recommends a policy of not balance billing for Village of Oak Brook residents.
After insurance pays their portion of the ambulance transport, Oak Brook residents will
not be billed. nor sent to collections for any remaining amounts when insurance is finished
paying.
REG BOT 052321 Ag€nda lr€m 8.A.1I Ord. G-1223, Ambulance Billing Rares Paee 3
Although conservative collection rates were used in the above estimates, actual 2022
collections were near 75% for those privately insured and 1 I % for self-pay . Given 2022
actuals, the estimated additional revenue with a $3,000 emergency medical service billing
rate could exceed $250,000.