When the North Dakota Department of Health realized that a lot of EMS agencies weren't billing for ambulance calls, they came up with a pilot project to offer free billing to 12 services. The contract for the two-year program went to Golden Heart Services in Rugby. That was 12 years ago, says Mark Weber, NREMT-P, EMS director at Heart of America Medical Center, Golden Heart Services. "During the first two years, those services went from having absolutely no money to having an increased bottom line," he says. "In North Dakota, a lot of them will never have a positive bottom line because they don't do many calls, but the program made them realize that billing is important and they can actually charge for their services. When I took over 11 years ago, eight services had the billing contract, and we increased that number to 67. Many residents in those communities were a bit shocked when they received a bill for ambulance transport, but they have also come to realize that providing EMS takes money and they want the services," says Weber. "We're trying to increase our Medicare reimbursement and state funding to ambulance services, and without local funding and billing appropriately, we'll never get where we need to be with state money."

     In addition to billing services, Golden Heart provides staffing to communities as far as 200 miles away when local volunteers aren't available. "The most remote service is a community of 200 residents in the middle of nowhere, about 50 minutes from a hospital," says Weber. "They only do about 30 calls a year, but they need an ambulance because it's so remote." The smaller towns pay for staffing and Golden Heart takes care of Worker's Comp, unemployment and social security, he says. "The most difficult part is finding the level of staff who can just show up at an ambulance service where they've never been before, get along with everyone, figure out how to find the residences and provide care in an unfamiliar ambulance. You have to have the right people to do that."

     —Marie Nordberg, Associate Editor