Denison Council Weighs Higher EMS Billing Rates After Study Finds Transports Priced Below Cost

By GvilleTX Newsroom

The Denison City Council was set to review and discuss higher emergency medical services rates for Denison Fire Rescue, an item tied to Senate Bill 916 and the city's FY2027 comprehensive fee schedule, according to the council meeting record. A consultant told council members the recommended rates would bring in roughly $149,000 to $150,000 more over one year than the current schedule produces. The rates set the amount the city bills for an ambulance transport.

Fire Chief Kenneth Jacks brought the item forward for Denison Fire Rescue and introduced Kevin Coyle of Revenue Optimization Solutions, who walked the council through the rate-setting work and the possible adjustments to EMS billing rates, the record shows.

Coyle's firm found the city charging less for transports than the transports cost. The record cites ALS-1 emergency service as one example: Denison's rate stood at $855 against a calculated cost-based figure of $1,786.64. The city's FY2024 fee schedule put ALS1 emergency and non-emergency base rates at $855 and the ALS2 base at $900. BLS base rates were $787, with mileage billed at $15.

Not every patient would pay the higher posted price. Denison Fire Rescue logged 4,241 EMS transports or billable events in FY2025, but Coyle told the council that fixed payers hold down how far a local increase reaches, naming Medicare, Medicaid, military or facility insurance, charity cases and patients from outside the city.

Some charges stay put under the proposal. Coyle recommended no change to EMS supply charges, and he told the council that SB 916 revenue would not cover calls where crews treat a patient in place or treat someone who is not transported.

Set against other agencies in the region, Coyle said the recommended rates fell inside the range other North Texas providers report to the Texas Department of Insurance EMS database, with some billing more and some billing less.

State rules cap how fast the numbers can move once they are filed. TDI guidance on SB 916 says a political subdivision may adjust its submitted emergency-services billing rates once a year, and only by the lesser of the Medicare Ambulance Inflation Factor or 10 percent. For 2026 that works out to a ceiling of 2 percent above the 2025 rate.

Ambulance service already ranks among the city's General Fund revenue lines. Denison's adopted FY2025/2026 budget recorded $1,612,105 in actual ambulance revenue for FY2024, estimated $1,875,000 for FY2025 and amended the FY2026 figure to $1,800,000.

The city describes its fire department EMS as a round-the-clock operation running advanced life support, basic life support and rescue calls. Billing and collection for emergency ambulance service goes to EMS|MC, which the city says won that contract effective in 2024.