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Ambulance Cost Data Collection & Payment Reform

Ambulance Cost Data Collection

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In 2012, the AAA engaged The Moran Company, a DC-based health care analytics firm, to determine the most appropriate way for the Centers for Medicare and Medicaid Services (CMS) to collect cost data from ambulance service suppliers and providers. Due to the high percentage of small ambulance service suppliers and the different types of ambulance service providers and suppliers, The Moran Company determined sending a tailored cost survey to a representative sampling of the industry was the best way for CMS to obtain the cost data. The Moran Company issued its findings in a report in April 2014.

In February 2018, Congress passed language directing CMS to collect ambulance cost data along with the 5-year extension of the Medicare ambulance add-ons as part of the Bipartisan Budget Act of 2018 (H.R. 1892). The language is based on a modified version of a provision included in the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2017 (S. 967). The language in H.R. 1892 sets the foundation for data collection based on a system similar to the one proposed by The Moran Company.

For more information about the findings of The Moran Company report, please access the below documents.

If you have questions about The Moran Company report or the development of an ambulance cost data collection system by CMS, please contact AAA Senior Vice President of Government Affairs Tristan North at

Payment Reform

Read the Joint Statement on Ambulance Reform

The American Ambulance Association (AAA), National Association of EMS Physicians (NAEMSP), National Association of EMTs (NAEMT), and National Association of State EMS Officials (NASEMSO) support the following policies that are necessary to stabilize the current Medicare ambulance benefit and set the stage for innovation. In brief, short-term reform includes:

  • Building current add-ons into the base rate (through the conversion factor);
  • Establishing the cost surveys; and
  • Shifting ambulance services from “suppliers” to “provider” status.

Read the full joint statement from 2016 (PDF download).

EMS providers are the only gatekeepers to the healthcare system in many communities. 73% of all ambulance suppliers credentialed with Medicare bill the program less than 1,000 transports per year. It is imperative that any cost data collection system reporting requirements consider this to ensure the reliability of the data and the administrative burden to ambulance providers and suppliers.

—Asbel Montes, VP of Governmental Relations & Reimbursement at Acadian Ambulance, Co-Chair of the AAA Payment Reform Committee
Support AAA Advocacy
Write a letter, or meet with your members of congress to educate them about the critical importance of sustainable EMS funding.

Permanent Add-On Relief

The efforts of the AAA’s legislative team and our members have given our industry nearly $2 billion in desperately needed Medicare relief over the last 12 years. It is time to make the temporary relief measures permanent. However, the AAA can’t accomplish this without your support and participation. Learn why your members of congress should support AAA’s ambulance payment reform efforts—download AAA’s most recent one page summary for legislators.

Get Involved

Ambulance Cost Survey

AAA’s goal is to ensure sustainable funding for ground ambulance services by more closely tying Medicare/Medicaid reimbursement rates to actual operating costs. In addition to making permanent the current temporary Medicare increases, we are advocating that Congress change the status of ambulance services from “suppliers” of health-related goods/services to “providers” of health care. Assuming our efforts to move to provider status are successful, ambulance services will then need to begin meeting “Conditions of Participation”—basic standards for health care organizations. One condition will be providing accurate cost data to CMS. Learn more►


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Provider Status

What does it mean when AAA mentions, “Supplier to Provider,” and what would this change mean for your ambulance service?

Fighting Fraud and Abuse

AAA and its members are deeply committed to ending fraud and abuse perpetuated by a few unscrupulous providers. Contact if you have any questions.

The Future of Ambulance Services and MIH/CP

Learn how moving from supplier to provider could help ambulance services meet the needs of their communities in new and innovative ways.

The Buzz on Payment Reform

Read Asbel Montes and Jimmy Johnson’s November 2016 opinion piece in the Journal of Emergency Medical Services (JEMS).

“To address the importance of the work that the payment reform committee is doing, we must consider the value of the part that small providers play in the healthcare delivery system today, and how imperative it is that we accomplish goals such as moving from Supplier to Provider status for all ambulance services in order to set the table for reimbursement that is more creative than just fee for transports. For example, 73% of all ambulance services who are credentialed by Medicare do less than 1,000 transports per year, which does not add up to sustainability for ambulances services endeavoring to adhere to best practices in providing emergency medical care. A vast majority of those services represented in the 73% are the first line—and in many cases the only line—of emergency medical care in their communities.”

Jimmy Johnson
Past President, American Ambulance Association
Co-Chair, American Ambulance Association Payment Reform Committee
Enid, OK

“EMS serves all Americans—24 hours per day, 7 days per week, 365 days per year. This is especially important in rural communities like mine, where hospitals and clinics may not be accessible to some of our most vulnerable populations, including the elderly, disabled, and chronically ill.

The American Ambulance Association’s legislative effort to ensure that government cost reporting requirements do not overly burden these mostly small healthcare providers has bipartisan support from coast to coast. At present, it is cosponsored by 30 representatives from 18 states as well as nine senators from both sides of the aisle. The same piece of legislation, the Medicare Ambulance Access, Fraud Prevention and Reform Act (H.R. 745, S. 377), ensures permanent, sustainable reimbursement for ambulance services, allowing us to stay focused on the most important part of the job—caring for you and your family in your time of need.

Please consider encouraging your members of congress to support the AAA’s legislation. A vote for AAA’s bill is a vote for the future of EMS in America.”

Check out this short video to learn more about what “Payment Reform” really means!

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