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One of the biggest challenges involved in providing superior prehospital care is obtaining the appropriate funding to pay for it. Funding is needed for salaries, equipment, as well as ongoing training. It seems that there is a disproportionate amount of money available for fire services, but these funds tend not to be as readily obtainable by emergency medical services (EMS). There are, of course, many models for EMS, all of which vary in their funding structure, but rarely does any model rely on a single revenue source. Similarly, each model has different requirements and often a different focus. For example, whereas a paid municipal department may rely heavily on tax revenues and government funding to pay for their employees and benefits, a private volunteer agency may receive no public funding and have minimal if any costs associated with payroll. However, both agencies would likely look to other funding sources such as private businesses, donations, state and federal grants, etc, to ensure the reliable delivery of high-quality care.

There is also variance among agencies regarding the level of service they are willing and able to provide, which may be a direct result of financial concerns. For example, some agencies choose to staff advanced life support ambulances only. Others choose to staff a mix of basic and advanced life support. Some choose to staff multiple ambulances to try to ensure their agency is the one providing timely service in the district, while others staff only a single ambulance, relying on surrounding agencies to cover their district when the primary agency is unavailable. These decisions of how to staff and the level of service to provide are often based on cost and resources but are key to strategic planning.

Another important aspect of EMS finance that varies among ­agencies is reimbursement. Serving a relatively poor population can be quite expensive, particularly if it is busy. Despite the high volume, low reimbursement rates and inability to collect on self-pay patients can lead to high losses. These agencies often are dependent on funding from the municipality as a public service. Conversely, serving an affluent area with patients carrying excellent insurance can be very lucrative, even with relatively low volume. Location near an institution with a large ­number of paid transfers can also be extremely lucrative. Regardless, finding funding sources to offset low reimbursements is critical to viability as is the ability to collect on bills. Variances in reimbursement vary not only locally, but regionally as well and these differences must all be considered when developing a budget and business strategy.


  • Describe sources of funding for EMS agencies.

  • Discuss levels of reimbursement for EMS.

  • Detail CMS (Centers for Medicare & Medicaid Services) criteria for reimbursement and discuss regional variability for reimbursement.

  • Define “payor mix” and discuss the financial impact of regional variability on EMS agencies.

  • Describe mileage as a modifier to ...

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