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I run 11 BLS & 3 ALS (1 EMT & 1 EMT-P) during the day M-F; 1 BLS & 1 ALS on the overnights Sun-Sat. On Sat during the day there's 5 BLS & 2 ALS. On Sun during the day there's 3 BLS & 1 ALS. The day tours are 13 1/3hrs. The overnight tours are 8hrs. That's a lot of $$$.. (This is not the salary) Say the EMTs are paid $10 and the EMT-Ps are paid $20 & you want to run one ALS (EMT & EMT-P) crew 24hours; looking at pay for the 24hrs, it is $720 on salary alone. For BLS it's $480. This doesn't include: health benefits, time-off, fuel, insurance, supplies, equipment, communication, & other costs; just to run 1 Ambulance 24hrs. Daily Operating costs are a lot. You're going to need more than 1 HD patient (that's only 1RT transport 3x week; for 6 transports). Hopefully, the HD patient has MCR (Medicare), most should but for EMS/PHC, it's MCR Part B we want. MCR Part A doesn't cover Ambulance Transportation. If you do get Doctor's Office and Clinics to call you for patient transportations to their office(s); you hope they have MK (Medicaid) because MCR doesn't pay for Ambulances going to Doctor's Appointments. Also, for Non-Emergency Transports, a PCS (Physician Certificate Statement) mush be filled, signed, printed, & dated by a Healthcare Practitioner stating/certifying that the patient is Ambulance necessary. If you're luckily enough to get Hospital Discharges; in NYS, the PCS must be generated but there is a NYS MK Pilot Form (which is a pink form) that is sent from NYS MK and the Hospital Practitioner (SW, MD, RN/CW, PA, NP) must sign before the Ambulance Company will get paid (this is to verify that the Hospital called for Ambulance Services & MK sends it months later). Reason being; a patient can not call for Non Emergency Transportation. For Emergency Calls going to an ER; anyone can call. In addition, for MCR patient(s), if there's a transport where the drop-off is out of your coverage area: you will have to collect for mileage. MCR will pay the base rate and 1 mile traveled; any additional miles traveled must be paid for by the patient or their Representative at the MCR discount rate of $7/mile... That's just the Entitlement Programs. How about them HMO/CMO/PPO/EPOs? For Emergencies going to the ER, not a big deal but for Non Emergencies; most need Prior Authorization. The Caller (Health Facility) must call the patient's insurance and request for Authorization to get Ambulance Services. It can be a difficult task. They have to prove necessity to the HMO (it is up to the Private Insurance if excessive mileage will be covered). Hospital to Hospital (IFT/Interfacility Transport(s) are not covered by any Insurance (for the most part); it's a Bill Hospital (I owe you) because of the DRG (Diagnosis Related Groups); continuity of care (care has not been completed by the first/sending Hospital; care needs to be continued at another Hospital due to capabilities). You can not bill the patient for these types of transports. You can not bill a patient who has insurance; where the Services provided are covered by their plan... Medical Coding & Billing Personnel should be on staff; billing can get really crazy and confusing... Sorry for being a mood killer... Check out this new article from JEMS; it's little bit old. My company has been dealing with this for months (really for years)... http://www.jems.com/article/ems-insider/ambulance-billing-reimbursement-update Click onto to the CMS link on Ambulance Fee Schedule...