AAA Releases Updated 2018 Medicare Rate Calculator

CMS Posts Updated 2018 Public Use File; OIG Guidance on Waiver of Small Cost-Sharing Balances Updated AAA 2018 Medicare Rate Calculator Now Available!

The Centers for Medicare and Medicaid Services (CMS) has posted an updated version of the 2018 Medicare Ambulance Fee Schedule Public Use Files (PUF). These files contain the Medicare allowed base rate reimbursement amounts for the various levels of ambulance service and mileage rates. These files reflect the restoration, retroactive to January 1, 2018, of the temporary add-ons for ground ambulance services (2% for urban transports, 3% for rural transports, and the “super-rural” bonus) pursuant to the Bipartisan Budget Act of 2018, which was enacted on February 9, 2018.

2018 Fee Schedule

Accuracy of Rates and AAA Fee Calculator

The American Ambulance Association has reviewed the rates in this file and confirmed that the rates are accurate. The AAA has also revised its Medicare Ambulance Rate Calculator to reflect the five-year extension of the ambulance add-ons as well as other policy changes including the two-year extension (2026 and 2027) of the 2% Medicare provider cut under sequestration and the additional 13% (23% total) cut to BLS nonemergency transports to and from dialysis centers. The additional dialysis transport cut takes effect on October 1, and as a modifier, is not included in the Public Use File.

Download the 2018 Rate Calculator

Reformatted Version of PUF

Unfortunately, CMS has elected in recent years to release its Public Use Files without state and payment locality headings. As a result, in order to look up the rates in your service area, you would need to know the CMS contract number assigned to your state. This is not something ambulance services would necessarily know off-hand. For this reason, the AAA has created a reformatted version of the CMS Medicare Ambulance Fee Schedule, which includes the state and payment locality headings. Members can access this reformatted fee schedule on the AAA website.

CMS has yet to announce a timetable for adjusting claims that were paid at the original fee schedule amounts. It is anticipated that CMS will make an announcement on this timetable in the next few weeks.

Coinsurance

One issue that frequently arises in these situations is how ambulance providers and suppliers should treat the additional coinsurance amounts that are generated when CMS and its contractors adjust claims from the original allowed amounts to the now higher allowed amounts. These additional coinsurance amounts are typically quite small. Ambulance providers and suppliers may determine that the costs associated with trying to collect these small amounts would likely exceed the amounts they could reasonably hope to collect. The question is whether writing off these small balances could be construed as a routine waiver of cost-sharing amounts, a practice prohibited under Medicare’s rules.

In 2010, the HHS Office of the Inspector General (OIG) issued guidance on this issue. Specifically, the OIG indicated that it would not seek to impose administrative sanctions on Medicare providers and suppliers that waive these amounts provided the following conditions are met:

• The waiver is limited to the increased cost-sharing amounts generated upon adjustment of claims previously paid at the lower allowable, i.e., it does not apply to cost-sharing amounts associated with claims paid at the increased allowables;
• The waiver is limited to the small balances created by the adjustment of claims, i.e., it does not apply to the cost-sharing amounts originally imposed on the beneficiary when the claim was paid at the lower amounts;
• The waiver must be offered uniformly to all affected beneficiaries;
• The waiver must not be advertised; and
• The waiver must not be conditioned on the beneficiary’s receipt of any items, suppliers, or services.

Assuming the above-referenced conditions are met, ambulance providers and supplier can safely write-off these small balances. Please note that the OIG is not indicating that ambulance providers and suppliers must write-off these amounts. Rather, the OIG is simply indicating that this is an option available to health care providers and suppliers impacted by retroactive adjustment of claims.

Download the 2018 Rate Calculator

2018 Fee Schedule

2018, Ambulance Fee Schedule, Centers for Medicare and Medicaid Services (CMS), Medicare


Brian Werfel

Brian S. Werfel, Esq. is a partner in Werfel & Werfel, PLLC, a New York based law firm specializing in Medicare issues related to the ambulance industry. Brian is a Medicare Consultant to the American Ambulance Association, and has authored numerous articles on Medicare reimbursement, most recently on issues such as the beneficiary signature requirement, repeat admissions and interrupted stays. He is a frequent lecturer on issues of ambulance coverage and reimbursement. Brian is co-author of the AAA’s Medicare Reference Manual for Ambulance, as well as the author of the AAA’s HIPAA Reference Manual. Brian is a graduate of the University of Pennsylvania and the Columbia School of Law. Prior to joining the firm in 2005, he specialized in mergers & acquisitions and commercial real estate at a prominent New York law firm. Werfel & Werfel, PLLC was founded by David M. Werfel, who has been the Medicare Consultant to the American Ambulance Association for over 20 years.