Ambulance Billing Services

Sussex County, Delaware
Request for Proposals
For
Ambulance Billing & Collection Services
Date Issued: June 1, 2026
Proposal Submission Deadline:
July 20, 2026 - 3:00 p.m. EST
Mail or Hand Deliver Proposal to Primary Contact:
Gina Jennings, Finance Director/COO
Sussex County Government
2 The Circle
PO Box 589
Georgetown, DE 19947

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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Table of Contents
Advertisement .................................................................................................................................. 3
Instructions for Proposals ................................................................................................................ 4
Background Information .................................................................................................................. 5
Scope of Services ............................................................................................................................. 8
Required Submittals ....................................................................................................................... 12
Insurance Requirements ................................................................................................................. 14
Evaluation and Selection Process .................................................................................................. 16
Contract Termination .................................................. .................................................................. 16
RFP Guidance: Question and Answers .......................................... ............................................... 16

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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Ambulance Billing & Collection Services
Public Advertisement - Request for Ambulance Billing & Collection Services
Sussex County, at the recommendation of the Finance Department and the Sussex County Volunteer
Firefighter's Association, is requesting proposals to provide comprehensive ambulance billing, collections,
and payment processing services for Basic Life Support (BLS) ambulance operations. The services
include:
Preparing and submitting claims to Medicare, Medicaid, private insurers, and self-pay patients
Managing all collections and payment processing
Providing detailed monthly financial reports and deposit summaries
Assisting with patient inquiries
Maintaining full compliance with all federal, state, and local applicable laws to include HIPAA and
Centers for Medicare & Medicaid Services (CMS) regulations and guidance related to Medicare
and Medicaid billing
Downloading all billable transport/treatment records from the electronic patient care reporting
system
Sussex County has determined that in order to obtain the most advantageous contract for Ambulance
Billing and Collection Services, factors beyond price will be taken into consideration. The criteria for
selection shall include experience and reputation, quality of scope of services, capacity to perform,
inclusion of added value services, and price. The award shall be made in writing to the respondent(s)
determined to be the most advantageous to Sussex County taking into account the evaluation criteria set
forth in the RFP. No other factors or criteria will be used in the evaluation.
Interested parties must submit two (2) written proposals to the Sussex County Finance Department,
Attention: Gina Jennings, Finance Director/COO, Administrative Office Building, 2 The Circle, Georgetown,
DE 19947, by 3:00 p.m. on July 20, 2026, at which time the proposals will be publicly opened and only the
name of each respondent will be read aloud and recorded. All other information shall remain confidential.
To be considered, priced proposals must be submitted in writing and respond to the items outlined in this
Request for Proposals (RFP). The award shall be made to the responsible respondent whose proposal is
determined to be the most advantageous to the County and the Sussex County Volunteer Firefighter's
Association.
The request for proposals may be obtained by visiting Sussex County's website
www.sussexcountyde.gov/legal-notices/bids or by contacting Mrs. Gina Jennings, Finance Director/COO at
the Sussex County Administrative Office Building, 2 The Circle, Georgetown, Delaware, telephone: (302)
855-7741, email: gjennings@sussexcountyde.gov. The proposals may be obtained during regular
business hours, which are 8:30 a.m. to 4:30 p.m., Monday through Friday. In its sole discretion, Sussex
County, Delaware, may extend the time and place for opening of bids from that described in the
advertisement by providing not less than two (2) calendar days' notice, by posting an Addendum on the
Sussex County website and by providing notice thereof by certified delivery, or other electronic means such
as email, to those potential respondents who obtained copies of the RFP or provided notice thereof to Gina
Jennings at the email address provided herein.

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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I. Instructions for Proposals
Each written proposal must be submitted in a sealed envelope, addressed to Mrs. Gina A. Jennings,
Finance Director/COO, Sussex County Administrative Office Building, 2 The Circle, P.O. Box 589,
Georgetown, DE 19947. Each sealed envelope containing a proposal must be plainly marked on the
outside as "Ambulance Billing and Collection Services RFP" and bear the name and address of the
respondent. If sent by mail, the sealed envelope should be sent by certified mail and be indicated as
received on the certified receipt prior to the Bid Opening. Late bids will not be accepted. Sussex County
may extend the time and place for opening of bids from that described in the advertisement, by providing
not less than two (2) calendar days' notice, by posting an Addendum on the Sussex County website and by
providing notice thereof by certified delivery, or other electronic means such as email, to those potential
respondents who obtained copies of the Request for Proposals and provided notice thereof to Gina
Jennings at the email address provided herein.
Sussex County reserves the right to reject any and all proposals, waive informalities in proposals received,
except with respect to the date, time, and place of submission, cancel this RFP in whole or in part, reissue
this RFP, and accept or reject items in proposals received. If this RFP is cancelled in whole or in part
before proposals are opened, all respondents shall receive notice of the cancellation and all proposals
received shall be returned unopened to the respective respondents.
FAX or emailed proposals will not be accepted.
Interested parties are asked to submit two (2) written proposals to the Sussex County Finance Department,
Attention: Gina Jennings, Finance Director/COO, Administrative Office Building, 2 The Circle, Georgetown,
DE 19947, by 3:00 p.m. on July 20, 2026, at which time the proposals will be publicly opened and only the
name of each respondent will be read aloud and recorded. All other information shall remain confidential.
Mailing Address: Mrs. Gina A. Jennings, Finance Director/COO
Sussex County Government
Administrative Office Building
2 The Circle
P.O. Box 589
Georgetown, DE 19947
Delivery Address: Mrs. Gina A. Jennings, Finance Director/COO
Sussex County Government
Administrative Office Building
2 The Circle
Georgetown, DE 19947
Telephone Number: (302) 855-7741
Proposed schedule:
Release date of RFP June 1, 2026
Due date for questions June 15, 2026
Receipt of proposal responses July 20, 2026
Expected Selection of vendor August 11, 2026
The selected vendor will enter into a tri-party agreement with the County and each participating
fire/ambulance company. The initial contract term shall be three (3) years, with up to two (2) additional one-
year renewal options, contingent upon satisfactory performance, continued need for services, and the
concurrence of Sussex County and the applicable fire/ambulance company.
The RFP and the selected respondent's proposal will become part of the contract.

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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II. Background Information
In Sussex County, there are 22 fire-ambulance companies operating independently from Sussex County
government. Twenty of the companies provide fire and ambulance services whereas two companies
provide only ambulance services.
Currently, all companies outsource their ambulance billing to third-party providers. Among the 22
companies, seven vendors are used to provide this service. Six companies use the same vendor but do not
have the same contract. Most companies do not have a set contract term. Typically, they must be renewed
annually or every three years.
Four fire companies are currently pursuing rescue billing for motor vehicle accidents. Three companies use
an independent company to perform collections; this can be the same firm used for ambulance billing but is
often a different firm.
The majority of the billing companies used today send two to three bills; the first bill goes to the insurance
company, and the balance bill goes to the patient. The average collection rate from 2019 to 2023 for all
companies was 61.56 percent. In 2023, $12.8 million was collected for ambulance billing.
The number of transports in Sussex County (excluding Rehoboth Beach):
2022 - 28,887
2023 - 29,539
2024 - 30,612
One company also provides Maryland-based calls. Although those calls are not part of this RFP, a
respondent may wish to identify, as an added service, whether it can also provide billing for those
Maryland-based calls. None of the statistics include those calls.
This table provides a contract summary for each company based on information gathered during a
countywide study performed by FACETS. If the chart contains a question mark, it means the company did
not provide FACETS with a clear answer regarding its current process.
Contract # of Rescue
Billing Start Subscription Bills Billing
Company Provider Date Term Billing Process Program Sent (Y/N)
Two bills sent
(insurance first,
then patient). No
Ambulance collections
American Billing Auto pursued after two
Legion Service 2010? Renew billing attempts. Yes? 2 No
Three bills sent.
Hard collections
after 120 days
Bethany (was previously 90
Beach Speclin 2/1/23 3 year days) Yes 2 Yes
Been
Ambulance with them
Billing for 15
Blades Service 6/1/24 years
They bill insurance
companies first.
Ambulance They write off the
Billing balance for
Bridgeville Service 6/1/24 Annual subscribers. Yes 2

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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Contract # of Rescue
Billing Start Subscription Bills Billing
Company Provider Date Term Billing Process Program Sent (Y/N)
Five attempts
AdvantEdg Multi- made, then written
Carlisle e year off. Yes 5 No
Bills insurance
first, then balance
bills the patient.
Three bills sent
before further
action.
Balance >180
days will be sent
to credit reporting /
Dagsboro Arete 01/01/18 collection agency 3 No
Bay Area
Receivables
Medical manages
Delmar Claim Aid collection Yes 3 No
Ambulance
Billing Multi-
Ellendale Service year No No
One bill sent to
insurance, one to
the patient.
Stops billing after
that.
American No collections, no
Frankford Legion rescue billing. 1 No
No collections
3 Bills
Annual - Bad Debt - GVFC
Auto looks at it after 12
Greenwood Emtech 2021 Renew months 3 No
Two to three
attempts to collect.
Bad debt must be
approved before
5 year - being written off.
Auto No collections
Gumboro Arete 8/18/18 Renew pursued. Yes 3 Yes
Ambulance Annual -
Billing Auto
Laurel Service 6/1/24 Renew
Two bills sent (soft
Speclin billing).
(previously Collections
Lewes DMMS) 3/1/23 3 years subcontracted. Yes 2
Bills insurance
first, then balance
bills the patient.
Three bills sent
before further
Memorial Arete 5 years action. 3

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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Contract # of Rescue
Billing Start Subscription Bills Billing
Company Provider Date Term Billing Process Program Sent (Y/N)
Can
terminate
with 2
Mid- mos.
Sussex Arete notice Send 3 bills Yes 3 No
Bill patients at
Ambulance least 2,
Billing commercial 3. In
Millsboro Service house collections Yes 3 No
One bill to
insurance + three
statements to
patients.
non-subscribers
sent to collections.
Emtech Rescue billing
(previously max: $500 per
Millville DMMS) call. Yes 4 Yes
Two bills are sent.
Ambulance Annual - No collections are
Billing auto- pursued.
Milton Service 6/1/24 renew No rescue billing. Yes 2 No
Insurance billed
first, three billing
cycles before
further action.
No collections for
in-district
residents; out-of-
Rehoboth Kirk & district residents
Beach Associates sent to collections. Yes 4
4 invoices and 1
call
Emtech Only do
(previously collections outside
Roxana DMMS) zip code Yes 4 Yes
3 year,
Emtech then one
(previously year auto
Seaford DMMS) 3/1/21 renew Yes
3 year,
Emtech then one
(previously year auto Three bills to
Selbyville DMMS) 11/1/24 renew patient. Yes 2 No

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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As provided in the FACETS study, net collection rates for each company are provided below.
Company 2019 2020 2021 2022 2023 AVG
American Legion N/A N/A N/A N/A 65.62% 65.62%
Bethany Beach N/A N/A N/A N/A 53.63% 53.63%
Blades N/A N/A N/A N/A 63.43% 63.43%
Bridgeville 61.52% 47.04% 64.52% 79.63% 65.82% 63.71%
Carlisle 45.92% 44.95% 43.83% 31.96% 69.44% 47.22%
Dagsboro N/A N/A N/A N/A 62.34% 62.34%
Delmar 75.59% 75.89% 76.74% 83.94% 82.97% 79.03%
Ellendale 78.43% 58.12% 63.52% 67.15% 62.67% 65.98%
Frankford 65.44% 66.43% 65.89% 77.59% N/A 68.84%
Greenwood N/A N/A 27.86% 50.01% 41% 39.73%
Gumboro 62.36% 73.60% 63.95% 64.32% 54.91% 63.83%
Laurel 70.88% 60.91% 57.90% 67.27% N/A 64.24%
Lewes N/A N/A N/A N/A 55.49% 55.49%
Memorial 47.64% 47.64% 40.34% 63.28% 43.79% 48.54%
Millsboro 74.25% 80.68% 73.59% 65.36% 72.02% 73.18%
Millville N/A N/A N/A 76.64% 78.80% 77.72%
Milton N/A N/A N/A N/A N/A N/A
Rehoboth Beach N/A 43.84% 55.41% 75.48% 97.86% 68.15%
Roxana 46.63% 67.40% 56.01% 86.36% 82.80% 67.84%
Seaford N/A N/A 31.38% 60.54% 58.97% 50.30%
Selbyville N/A 60.92% 44.99% 59.08% 48.14% 53.28%
AVG
Sussex
Rate 61.61%
III. Scope of Services
Although not mandatory, it is anticipated that every company providing ambulance services in Sussex
County may utilize this agreement at some point in the future. Existing company contracts may prevent
some companies from using the services immediately. Although the contract will be paid by Sussex
County, the agreement will be among the awarded vendor, the fire/ambulance company receiving the
service, and Sussex County, which will be responsible for payment. Responsibilities for each party are
described below and will be further defined in the final contract. The billing and collection methods,
excluding any subscription programs established by individual companies, will be uniform for each
company using this contract. Currently, each company sets their own billing rates where they would need
to communicate those rates and any changes to the billing company. However, we are asking potential
bidders to provide two different cost proposals if the bidder's cost proposal would be different if all
fire/ambulance use one set of rates for all companies participating in this agreement.
The initial contract term for each tri-party agreement shall be three (3) years, with up to two (2) additional
one-year renewal options, contingent upon satisfactory performance, continued need for services, and the
concurrence of Sussex County and the applicable fire/ambulance company.

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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The following services are needed for each company who utilizes this contract:
1. Downloading all billable transport/treatment records from the electronic care report system. The
system that is required to be used by all State of Delaware companies providing ambulance
services is ImageTrend.
2. Reviewing downloaded data for accuracy, completeness, and regulatory compliance prior to
beginning the billing process
3. Preparing and submitting claims to Medicare, Medicaid, private insurers, and self-pay patients
4. Managing all collections and payment processing which includes tracking patient payment plans
5. Communicating, well in advance, any changes to rates, reporting requirements, or laws affecting
ambulance billing and reporting
6. Assisting with patient inquiries
7. Maintaining full compliance with all federal, state, and local applicable laws to include HIPAA and
Centers for Medicare & Medicaid Services (CMS) regulations and guidance related to Medicare
and Medicaid billing
8. Depositing collections to each applicable fire/ambulance company's bank account
9. Mailing Notice of Privacy Practices to all transported patients
10. Providing a monthly bill for services rendered to Sussex County that shows monthly collections by
company
It is expected that the awarded vendor will maximize collections, minimize outstanding balances, and
provide responsive, professional customer service to the fire/ambulance company, the County and
patients.
If the respondent cannot provide all services required under this RFP, the respondent may subcontract
certain services, such as collections. However, the County will award this RFP to only one respondent. If
the respondent plans to subcontract any services identified in the RFP, the respondent shall disclose the
subcontractors in its proposal.
The following tables outline the responsibilities of each entity and will be included in the future contract:
Billing Responsibilities
Responsibility Description
Electronic Billing Integration The awarded vendor must support billing integration with the
approved electronic patient care reporting system and accept
electronic data transfers from the system.
Data Submission Requirements The awarded vendor shall provide documentation to each
fire/ambulance company regarding the information that must be
reported for each call so that a transport can be billed accurately.
Data Submission by fire/ambulance The fire/ambulance company will report all transport data through
company the electronic patient care reporting system required by the State
of Delaware and will be responsible for properly recording all
required information to legally bill insurance, Medicare and
Medicaid
Data Submission Verification The awarded vendor must contact the fire/ambulance company if
all required information has not been provided in order to bill the
patient properly as soon as possible but within 24-48 hours the
information being entered in the reporting system by the
fire/ambulance company. The fire/ambulance company shall be
responsible for providing the missing or corrected information,
except for signature collection as described below.
Signature Collection Fire/ambulance personnel will attempt to obtain the patient's
signature. If unsuccessful, the awarded vendor must make
reasonable efforts to obtain the signature post-transport.

Sussex County, Delaware RFP: Ambulance Billing and Collection Services
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Responsibility Description
Subscription Program The fire/ambulance company shall provide a copy of its
subscription program to the awarded vendor.
The awarded vendor must provide feedback within 30 days if it
cannot follow the program because the program does not meet
Medicare or Medicaid non-discrimination requirements.
Subscription Lists Fire/ambulance company will provide updated subscription lists to
the awarded vendor to ensure proper billing of subscriber patients.
The subscription list will be honored by all fire/ambulance
companies who take part of this contract.
Tracking Period The awarded vendor shall track all transport and revenue data
based on each fire/ambulance company's fiscal year.
Balance Adjustments The awarded vendor shall not reduce or write off patient balances
without written approval from the applicable fire/ambulance
company's designee.
Contract Administration Contact The awarded vendor must designate an authorized representative
to manage day-to-day communications with each fire/ambulance
company.
Ambulance/Fire Company Contact The ambulance/fire company must designate an authorized
representative to respond to the awarded vendor's day-to-day
communications.
Collections Protocols (see table The awarded vendor shall adhere to the collections protocol set
below) forth in this RFP.
Electronic Claim Submission The awarded vendor shall use electronic submission for Medicare
and Medicaid claims and, when possible, for all other insurers.
Paper claims may be used only when electronic submission is not
possible.
Pre-Screening of Claims The awarded vendor must verify each claim's compliance with
payer requirements and applicable laws, including physician
certification, medical necessity, and assignment of benefits, as
applicable.
Insurance Verification The awarded vendor must verify insurance eligibility using
commercial databases and other accepted tools before submitting
claims.
Indemnification The awarded vendor shall indemnify and hold harmless each
fire/ambulance company and the County from any losses or claims
arising from the awarded vendor's performance, billing errors, or
failure to act.
Each fire/ambulance company shall indemnify and hold harmless
the County and the awarded vendor for billing errors based on
information provided by that fire/ambulance company.
Privacy Notice The awarded vendor will mail a Notice of Privacy Practices to each
transported patient. This notice is required to be sent only once
per patient, regardless of the number of transports received.