Quick answer: An RFP for EMS billing services should describe your service and volume, define the exact scope of work, require the same pricing format from every bidder, ask specific questions about reporting, compliance and transition, and publish a weighted scoring method before proposals arrive. That makes proposals comparable and the award easier to defend to a board or council.
Public agencies often buy billing services through a formal request for proposals. Sussex County, Delaware, for example, issued an RFP covering claims to Medicare, Medicaid, private insurers and self-pay patients, collections and payment processing, monthly financial reports and deposit summaries, patient inquiries, HIPAA and CMS compliance, and downloading transport records from its ePCR system (Sussex County). A clear RFP is the difference between five proposals you can compare and five you cannot.
When to run an RFP
- Your purchasing rules require one for a contract of this size
- Your current billing contract is within 6 to 9 months of its end date
- Collections, denials or reporting have fallen short and you want to test the market
- You are moving from in-house billing to an outside vendor; our in-house vs outsourced cost comparison helps you decide first
Follow your own state and local procurement rules on notice, deadlines, evaluation and award. This guide covers what to put in the document, not the legal process.
What to include in an EMS billing RFP
| Section | What to include |
|---|---|
| 1. Background | Who you are, service area, number of units, current billing setup |
| 2. Volume and payer data | Transports per year by type (emergency, non-emergency, specialty care), payer mix, annual charges and collections, current AR by aging bucket |
| 3. Scope of work | Every task the vendor must perform: coding, claim submission, payment posting, denials and appeals, AR follow-up, patient statements and calls, collections referrals, reporting |
| 4. Technology | Your ePCR system, how data must flow, who owns the data |
| 5. Reporting | Required monthly reports and KPI definitions, such as clean claim rate, denial rate, days in AR and collection rate |
| 6. Compliance | Business Associate Agreement, HIPAA safeguards, coding audit process, overpayment handling |
| 7. Transition | Go-live date, handling of existing AR, onboarding plan |
| 8. Pricing form | One required format for every bidder, with fee type, rate and every extra listed |
| 9. Evaluation | Scoring criteria and weights, and whether interviews will be held |
| 10. Submission | Deadline, format, contact for questions, references required |
The pricing form matters most. If bidders choose their own format, one quotes a percentage, another a per-claim fee, and a third leaves out statements and postage. Require every bidder to state its all-in cost on the volume you publish. Our guide to ambulance billing services cost explains the pricing models and common extras.
Questions to require from every bidder
Ask for written answers to the same questions, so proposals can be scored side by side:
- How many ambulance or EMS clients do you serve today, and how many are similar to us in size and transport mix?
- What share of your business is ambulance billing?
- How do your coders decide between BLS, ALS1, ALS2 and SCT, and what ambulance-specific training do they have?
- Which KPIs will you report monthly, and how is each one calculated? Attach a sample report.
- How quickly do you work denials, and who files appeals?
- How will you connect to our ePCR system?
- How will you handle claims already open on our go-live date, and at what rate?
- Will you sign our Business Associate Agreement before receiving any patient data?
- How do you audit your own coding, and how do you report and refund overpayments?
- Where will Medicare and other payer deposits go? (Medicare pays a billing agent directly only if its pay is not tied to amounts billed or collected, per 42 CFR 424.73.)
- What is your onboarding plan, with dates and named roles?
- What are the contract term, notice period and data-return terms?
- Provide three references from current clients of similar size.
Our 15 questions to ask an EMS billing company explains what a good answer to each looks like.
Weighted scoring sheet
Publish the weights in the RFP so bidders know how they will be judged. Adjust them to your priorities.
| Criterion | Weight | What earns full points |
|---|---|---|
| Ambulance billing experience and references | 20% | Several current clients of similar size; references confirm results |
| Reporting and performance | 20% | Monthly KPI report with stated formulas; sample provided; clear denial turnaround |
| Price (all-in annual cost) | 20% | Lowest all-in cost on the published volume, with every extra listed |
| Compliance and data security | 15% | BAA signed before data sharing; written audit and overpayment process; deposits in agency’s name |
| Transition plan | 15% | Dated onboarding plan; clear handling of existing AR; named contacts |
| Technology and integration | 10% | Named integration with your ePCR; data returned in a stated format |
Score each criterion from 1 to 5, multiply by its weight, and add the results for a total out of 5. Price is one criterion, not the whole decision. When Cabell County EMS in West Virginia compared five billing proposals, its director said the county did not have to choose the lowest bid and would weigh experience with a service of its size, reputation and client retention alongside cost (Herald-Dispatch).
Timeline from posting to go-live
A typical sequence, to adjust to your purchasing rules and board calendar:
| Stage | Typical length |
|---|---|
| Gather volume, payer and AR data; write the RFP | 2 to 4 weeks |
| RFP open for questions and proposals | 3 to 4 weeks |
| Score proposals, check references, interview finalists | 2 to 3 weeks |
| Board or council approval and contract signing | 2 to 6 weeks, depending on meeting dates |
| Onboarding and go-live | 2 to 8 weeks |
Leave enough room before your current contract ends. Gaps in billing cost real money: when Cabell County EMS stopped in-house billing in October before a December 1 vendor start, the remaining billing staff spent the gap working claims already filed, denials and payment posting, and the new vendor’s work was set to reach back to October (Herald-Dispatch). Our 60-day checklist for switching ambulance billing companies covers the handoff after award.
AmbulanceMedicalBilling.com responds to EMS billing RFPs from municipal, county and fire department agencies. A free billing audit can also give you the volume and AR baseline that section 2 of your RFP needs.
Frequently asked questions
What should an EMS billing RFP include?
Background on your service, transport volume and payer mix, a detailed scope of work, technology and reporting requirements, compliance terms including a BAA, a transition plan, a required pricing form, evaluation criteria with weights, and submission instructions.
How long does an EMS billing RFP take?
From drafting to go-live, often 3 to 6 months, depending on how long the RFP stays open, board or council meeting dates, and the onboarding period.
How do you score ambulance billing proposals?
Use published weights for experience and references, reporting, all-in price, compliance, transition and technology. Score each from 1 to 5, multiply by its weight and compare totals.
Should the lowest bid win an EMS billing RFP?
Not automatically, unless your procurement rules require it. A lower fee can cost more if collections fall or denials go unworked, so many agencies score price alongside experience, reporting and transition plans.
What data should we give bidders?
Annual transports by type, payer mix, annual charges and collections, current AR by aging bucket, your ePCR system, and the services you want included. Bidders cannot price accurately without it.