DELAWARE — The city of Delaware is preparing to hire a new emergency medical services (EMS) billing vendor after Delaware County announced it would end a decades-long reimbursement arrangement at the end of this year.
Delaware City Council recently heard an update from Fire Chief Tim Pyle, Assistant Fire Chief Chris Neading and Cindy Collins, a procurement specialist in the city’s finance department, about the city’s plans to seek a new vendor.
City Attorney David Moser said council approved an agreement several months ago allowing the county to continue reimbursing the city for EMS billing services through Dec. 31.
With that funding set to expire, Moser said city officials hope to have a new billing arrangement in place by Jan. 1, 2027.
“As you recall [these reimbursements] are a historical practice, very long standing for multiple decades, that the county informed us … they were pulling that funding and would no longer be extending the term of [the city of Delaware’s] contract,” Moser said.
EMS billing involves charging for ambulance and related emergency medical services.
For example, according to the Liberty Township Fire Department, its EMS billing includes fees for ambulance transportation to hospitals, calls for assistance and incidents that do not result in patient transport.
How this affects Delaware residents
What residents might have to pay for EMS services remains undecided, Moser said, with three billing options under consideration.
“In terms of the framework for the options for billing, there are generally three potentials,” Moser said.
“Insurance-only billing is exactly like it sounds. After an ambulance or an EMS run, the city will bill through this vendor only the health insurance of the patient or Medicare/Medicaid as applicable. If there is any remaining balance afterwards, copays, deductibles, etc., those are waived. So there is zero out-of-pocket for eligible patients, there’s no bill that a resident is going to receive and have to foot on their own.
“Soft billing is a kind of a hybrid of that [insurance-only]. We again pursue payment from the insurance, out-of-pocket balances are billed via letters but are not aggressively pursued.
“Hard billing [is when] any remaining balance is aggressively pursued. Most often, with our neighboring municipalities, they’re sent to the Ohio Attorney General for collection.”
Moser said city staff is leaning toward an approach that would bill only insurance providers for city residents, while nonresidents would be subject to hard billing, including collection of unpaid balances.
However, City Council has not made a final decision, and all three billing options remain under consideration.
How the Delaware Fire Department is funded
In 2010, voters passed a permanent 0.3% income tax levy for the Delaware Fire Department.
Prior to that levy’s passage, the fire department brought in revenue from city income taxes, property taxes (levy assessed for firefighter pension obligation), impact fees associated with new residential construction, reimbursements from Delaware County EMS and the city of Delaware’s general fund, Pyle explained.
The 2010 levy allowed the fire department to move away from relying on the city’s general fund, establish a capital improvement plan, build two new fire stations with a third now under construction, upgrade vehicles and equipment, and improve its Insurance Services Office (ISO) rating.
With the fire department no longer relying on the city’s general fund or using property tax revenue to cover pension obligations, its remaining funding sources are city income taxes, impact fees and Delaware County EMS reimbursements.
Now that Delaware County’s EMS reimbursements set to end, the fire department will be left with two funding sources: income tax revenue from the 2010 levy and impact fees. The loss of county reimbursements is expected to create an approximately $1.1 million funding shortfall.
“To give you an idea, some perspective, on average about five to seven percent of the revenues that come in are a result of the county reimbursements,” Finance Director Alycia Hefner said.
“This is over a million dollars a year. I would also like to point out that while we did renew the contract [with the county], in 2026, to date, we have not received any payments from the county for this reimbursement,” she said.
“This is equivalent to the debt service for Station 305, or it could be 10 entry-level firefighter/EMTs coming onboard, or two medic units.”
Hefner said the county’s change has an impact and that the change was “unforeseen.”
“To compensate, there are a few things we can evaluate,” Hefner said. “The easiest one to prevent losses in service is to look at and consider the implementation of EMS billing.
“Conservative estimates on the lowest end that I’ve seen put this at about $1.3 million in revenue, which is on par with the county reimbursement.”
However, if the city decides not to implement EMS billing services in the future, Hefner said the department may have to delay routine equipment requests or halt additional staffing requests.
Comparisons to other local fire departments
Neading said every EMS transport agency in Delaware County utilizes EMS billing.
“We’re the only EMS transport agency that does not use EMS billing,” he said.
“Other players in central Ohio, the city of Columbus, the city of Westerville and Washington Township, ones who have similar structure to us and similar run volume, similar financial documents and staffing as well, all utilize EMS billing.”
Neading said once the Delaware Fire Department saw these surrounding agencies utilize EMS billing, it made them feel comfortable moving forward with the service.
The city issued an RFP for EMS billing services on Sept. 9, and Collins said seven third-party vendors responded to the RFP, a number she was proud of.
If council approves one of the seven vendors’ proposals during its Nov. 9 meeting, an EMS billing service would launch in the city on Jan. 1, 2027.
From a high level, the city’s RFP included the following in its scope of services:
- Collect & submit revenues for EMS billing
- Comply with applicable laws & guidelines
- Resident communication plan
- Controls for fraudulent & duplicative billing
- Toll free number for citizens managed by the vendor, not the city
- Training for staff
- Portal for billing data
- Quality assurance program
“The best way I can describe it is that this vendor would be coming in and it would be soup to nuts,” Collins said.
“One of the top tiers that we wanted to highlight is the vendor that would be selected for this contract is to assist us in developing and issuing a marketing and communication plan for our residents.
“We understand that this is a shift; that was very important to us.”
