City administrators presented the 2024 Cleveland Emergency Medical Services (EMS) budget proposal on Wednesday with projected revenues of more than $11 million, an almost $2.5 million increase from 2023.
That would reverse the trend from 2021 to 2023, when revenues plummeted from $16.8 million to $8.5 million, despite a rate increase for EMS services in 2022. The projected increase reflects a plan to outsource billing to a third party provider in the second half of the year, according to Ahmed Abonamah, the city’s chief financial officer.
The city’s request for proposals from billing service providers says there is a backlog of “around 40,000” claims.
The city has five medical billing and coding employees working on EMS but should have 15, Council Member Michael Polensek pointed out during the budget hearing.
As a result, claims are going unprocessed, according to Timothy Sommerfelt, a representative of the Cleveland Association of Rescue Employees (CARE), the union for EMTs and paramedics.
“Some insurers require that bills be submitted for reimbursement within a certain time period,” Sommerfelt told Signal Cleveland in a text message. “Since there aren’t enough [city] employees, they can’t keep up with the volume.”
Abonamah told City Council members that other cities that have hired third parties to handle EMS billing have seen double-digit revenue increases.
Sommerfelt said most patients Cleveland EMS serves have insurance. About 55% of patients have either Medicaid or Medicaid alternatives, he said.
If an ambulance service accepts a Medicaid reimbursement, it cannot charge the patient the remaining balance, Sommerfelt said. For example, “if someone receives a bill for $800, and Medicaid reimburses $144, the city must accept the $144” and can’t charge the patient more, Sommerfelt said.
No Cleveland EMS budget increase, but more money will be available
The proposed 2024 EMS budget is $36,461,249, the same as last year.
Council Member Jenny Spencer said that is concerning because it implies the city is not investing in EMS. But Abonamah said that while there is no increase in the 2024 budget, the city did invest additional funds in 2023.
The EMS budget increased $2.3 million after union contract agreements were settled, according to data Sommerfelt shared with Signal Cleveland. The additional funds went toward a one-time retroactive pay increase. “Moving forward, that money should be available for other uses within EMS,” Sommerfelt said.
In 2023, the union signed an agreement with the city increasing starting pay for experienced paramedics transferring to Cleveland. Union leaders said at the time that the pay increase would help the division’s recruitment efforts.
