Code of Iowa Section 331.385 and Section 331.424C allow cities and townships to enter into 28E fire township and emergency management services (EMS) agreements. Some cities rely on donations or property taxes to pay for these services, however as medical costs go up and the demand on property taxes continues to increase, many services are turning to user fees to cover the cost of the services for fire and EMS.
Cities that provide fire or emergency medical services have unique challenges collecting the fees from the patient or the patient’s family. Often the patient will expect that the city will accept the payments from insurance companies, even if the insurance company only wishes to pay “usual or customary fees”.
To further complicate the collection process, many different agencies may be involved in an EMS claim such as Medicare, Medicaid, bankruptcy courts, worker’s compensation, Veteran’s services, contract and Intercept.
Cities should charge for their EMS services at least to the level of Medicare approved rates. For patients on Medicare or Medicaid, however, the city must accept assignment of the fees. Cities must also be in compliance with the Affordable Care Act of 2010. On the other end of the spectrum, cities that set EMS rates too low or do not review the fee structure on a regular basis typically only benefit insurance companies, federal and state Medicare and Medicaid programs.
Many cities are turning to a third party to bill out the EMS services because of the complexity of filing fees and following through on the collection. It is a good practice to do a request for services (a form of bidding) to make sure the company can handle efficient effective collection. The third party provider should also demonstrate a knowledgeable staff of billing and collection professionals with the ambulance, fire, and medical experience. The company must be able to demonstrate complete, accurate and timely fire & EMS billing through references. Services might include:
- Fire and/or EMS billing practices
- Immediate electronic claims submission to maximize cash flow
- Professional Customer Service
- Accurate, complete and timely reporting
- Customized documentation and compliance training for city staff
- Compliance with state and federal regulations (such as HIPAA Privacy & Security Regulations for Third Party Billing Services and Medicare/Medicaid authorizations)
- Capacity to transmit billing information compatible with city’s accounting software
Hazardous Material Fee Recovery
The billing of hazardous material fees recovery is probably the most commonly charged fee within fire departments. Many use the standardized fee schedule shown on the link above. These fees are updated annually and offer uniformity in charging insurance carriers as well as individuals.
Other Miscellaneous Service Fees
Some cities charge flat rates while others charge per hour for each piece of equipment responding and the manpower required to operate them. Some of these services include:
- Car Fires
- False alarms
- Illegal burning
- Individual pieces of equipment: a rescue truck, pumper or use of air packs
Structural Fire Fees
Some argue that structural fires should be covered by the property taxes paid by citizens inside and outside of the city. This policy may be disputed using a comparison with the structure for water or sewer fees. Everyone pays a basic fee and an additional amount for the amount actually used. Another argument against property taxes covering fires is that not all tax payers in a particular district may use the same proportion of taxes towards fire or EMS services. For example, a township resident may not be contributing as much for the fire protection as a resident within city limits. Many use the standardized formula for sharing services between township residents and the city and still feel compelled to charge for structural fires based on the time used for the engine and minimum manning.
Fire Fighting Equipment Revolving Loan Fund
The Fire Service Training Bureau administers the Fire Fighting Equipment Revolving Loan Fund. The fund, which was established by an appropriation from the Iowa General Assembly, makes loans to local fire departments for purchases and repairs of critical equipment, which would be impractical for those departments to obtain otherwise. This fund has been initiated through the legislative efforts of our Association.
Acceptance of Gifts Between Departments
Many “gifts” can be made between fire and EMS departments when replacement equipment is available and the trade in value of the old equipment is of little or no value. Each department is encouraged to execute a “as is” agreement which releases the giving agency from liability from the receiving agency. Find an example, note: Equipment such as hose and turnout gear can be gifted to another department. The example document should be executed before accepting the gift.
Each year two scholarships are offered from the Reynold Hentges Memorial Scholarship, available from the Iowa Chapter of the International Association of Arson Investigators (IAAI). These $500 scholarships are offered to students entering the fire service, law enforcement, legal (prosecution) or insurance (investigation) professions. The application deadline is July 1 of each year. An application can be obtained from any area community college. Applications are also available from: Iowa Chapter, International Association of Arson Investigators, Inc.
FEMA Assistance to Firefighter Grant Program
A program of the Federal Emergency Management Agency (FEMA), grants are awarded to fire departments to enhance their ability to protect the public and fire service personnel from fire and related hazards. Three types of grants are available: Assistance to Firefighters Grant (AFG), Fire Prevention and Safety (FP&S), and Staffing for Adequate Fire and Emergency Response (SAFER). Additional information on the Assistance to Firefighter Grants.