By Hannah Wade
The State
LEXINGTON COUNTY, S.C. 鈥� In the year after Lexington County began contracting with a third-party, private medical company to handle less critical calls for help, collections for rides in county ambulances dropped by more than a quarter.
The amount of money collected for ambulance rides dropped by more than $3 million 鈥� from $13.7 million in the fiscal year 2023 to $10.6 million the next year 鈥� after the county started partnering with MedTrust. County officials say they鈥檙e OK with that because it means they鈥檝e been able to improve response times and they believe the numbers will rebound in the future.
In that same time frame, in 2023 to As the collections continue to tick back up from dropping significantly in 2024, the emergency medical services department is set to receive $27 million this coming year, after the county council approved the budget June 10.
The county parted ways with the billing company it had long employed for EMS collections last year, switching to a new provider that promised to increase revenue. But even though the revenue is slowly increasing, the company has not brought the county back to where it was in 2023. Local leaders say they aren鈥檛 worried, but when exactly the county鈥檚 EMS revenues will rebound remains unclear.
What caused the dip in revenues?
For decades, Lexington EMS has used a third-party billing company to collect payments for rides to the hospital.
Typically, the ambulance staff works to get certain data like insurance and contact information from the person receiving services. That information gets sent to the billing company, which works to collect the money; either from insurance companies, Medicare, Medicaid or directly from the patient.
For more than three decades, a local company, Lowcountry Billing Services, collected those bills for Lexington. But in the spring of last year, after a company from New York sold the county on new technologies and the promise of higher collection amounts, Lexington moved from its longtime provider to Digitech. In two different evaluations by a committee of four, the group chose the new company over the old one each time.
Digitech sold the committee on the potential of increasing the annual revenue for EMS collections by $4 million. During the proposal process, Lowcountry Billing received poor marks across the board on its ability to provide revenue projections.
But since Digitech took over the billing for the county in July of last year through the end of March, which is as recent as the data is publicly available, the company has only collected around $6.1 million. If it continues on that path, the company would collect $8.2 million in payments through the fiscal year, which is $2.4 million less than Lowcountry Billing brought in the previous year, all while keeping more of a percentage of those collections for itself than Lowcountry did.
The amount Digitech has collected doesn鈥檛 represent the total amount of collections, though. Because of the way that collecting older debt works, the county will continue to pay Lowcountry for collecting aged debt for just shy of the next decade. From July 2024 until March 2025, the county paid Lowcountry $114,840, which would equate to at least $4.1 million in collections based on the amount the company was paid and the percentage of collected money it uses to calculate how much the county will pay it.
That number is complicated, though, county officials said. Bills for ambulance services are typically split up based on how old they are 鈥� the billing company is typically responsible for collecting payments on debt that鈥檚 less than a year old. If someone hasn鈥檛 paid their bill within a year, the billing company has either had the patient enrolled in a payment plan or has sent it to the state to handle, but that number is still calculated into the amount of total collections the company made. The state makes an attempt to collect that debt for a decade, either through taking money from individual tax refunds or garnishing wages. If the bill isn鈥檛 paid in a decade, the county writes off that debt.
Because Digitech has only been contracted out by the county since July of last year, the company isn鈥檛 collecting debt that鈥檚 older than a year, EMS Chief Brian Hood told The State. Whereas, Lowcountry Billing was collecting new debt on top of older, aged debt. Comparing the two would be like comparing apples to oranges, Hood said.
From July 2024 until January 2025, Digitech collected $4.2 million, a $415,000 increase in revenues from what Lowcountry collected in similar funds in the same timeframe a year earlier, according to numbers provided by the county. But between February to the end of the fiscal year in June, the company would need to collect $4.6 million to match what Lowcountry had in similar collections the year prior.
The company had to contend with fewer calls being billed directly to the county, Hood explained. In December 2022, Lexington began outsourcing some low-acuity EMS calls to MedTrust, a Charleston-based private ambulance company, which Hood said contributed to the drop in revenue in 2023. By January 2024, the county was outsourcing more than a fifth of its calls to MedTrust. The county entered into a contract to pay the company an estimated $743,000 over five years for the service, but doesn鈥檛 touch any of the collections MedTrust makes for ambulance rides.
鈥淲hile Lowcountry had the benefit of historical call volume to absorb that reduction in calls, Digitech did not, and is still outperforming Lowcountry on current collections,鈥� Hood said.
Officials with Lowcountry Billing said the county gave them billing data sporadically and without a consistent schedule, which made it 鈥渋mpossible to maintain stable monthly collection trends.鈥� The company posited that it requested more regular data from the county and that the irregular delivery led to months of artificially low collections.
鈥淚t鈥檚 misleading at best to claim Lowcountry is being outpaced by another vendor when only selective data is being shared 鈥� not the full picture. When you cherry-pick numbers, you can make almost anything seem true. But a fair, full-cycle comparison tells a different story. We stand proudly on our track record and the integrity of our service,鈥� Jeff Sarokas, a co-owner of Lowcountry Billing, told The State.
The promise from Digitech of a $4 million increase in revenues over the fiscal year hasn鈥檛 been kept, but Hood said he believes the company is on the trajectory to increase collections in the coming years.
What鈥檚 the impact?
The money collected from county ambulance services goes directly to Lexington鈥檚 general fund, which is then allocated out to various departments, including emergency medical services.
The department requested a little more than $27 million for the upcoming fiscal year, after spending $21.6 million last year. That includes money for paying salaries, $2.2 million for new ambulances and more than half a million for billing services. Based on the percentage that Digitech takes for billing patients, if the county pays the company what it鈥檚 budgeted next year, the company would collect at least $14.4 million.
Hood said that although the partnership with MedTrust meant that the county saw the drop-off in revenue, offloading the lower acuity calls to the private company has saved the county time and resources overall. It also allowed the county to get more of a grasp on 911 calls than in the past 鈥� a growing pain of the county鈥檚 growth had been that an overburdened, understaffed EMS department wasn鈥檛 responding quickly enough to calls.
Since the county entered into the MedTrust agreement in December 2022, EMS is hitting more reasonable numbers for response times, Hood said. MedTrust, which handles less critical calls, has to respond within 60 minutes of a call, by its contract. The county has 36 minutes to respond to low acuity calls it picks up, 24 minutes for medium acuity and 12 for high acuity. Since MedTrust has partnered with Lexington, EMS is meeting those numbers over 90% of the time, Hood said.
While the dip in revenue after the county began partnering with MedTrust hasn鈥檛 lined up exactly with a dip in expenditures, Deputy County Administrator Ted Luckadoo said emergency services, including the fire department, had seen a decrease in fuel costs since the county began contracting out lower acuity calls.
鈥淭he goal was not for us to see a corollary decrease in expenses with the decrease in call volume. The goal from the outset was always to see a decrease in response times, because of that decrease in call volumes and we have absolutely seen that,鈥� Hood said.
漏2025 The State. Visit . Distributed by