Author: AAA Staff

“Save Lives, Not Seconds” member editorial

Don’t miss the fantastic member-written editorial, Save lives, not seconds, in Wednesday’s Boston Globe. Submitted by Cataldo Ambulance’s Tom Kimball, it gets to the heart of many issues with using response times as the only performance metric. (Emphasis below is ours.)

Many cities and towns in Massachusetts still judge the performance of their ambulance services using metrics like response times, which can miss the point. An additional two minutes waiting for an ambulance will rarely make a difference for a trauma patient facing emergency surgery that may take hours.

Patient outcome is a more valuable measure of whether a medical service is doing right by people. In many areas of health care these days, it is the gold standard, a key factor in determining how much insurance companies pay service providers. Changing the terms of ambulance companies’ contracts to make good patient outcomes the goal could greatly improve the quality of medical care across the state — and save lives.

Read the full editorial over at the Boston Globe. 

Employee Background Check Benefit for Members

AAA is excited to announce that members now receive deeply discounted rates on employee background screening through Sterling Talent Solutions.

Contact our representative, Steven McGinn, for a fast, easy comparative quote at the AAA member discount. (Please note that our discount is only available through Steven.)

Steven McGinn
AAA Sales Executive

Protect your patients, your service, and your wallet. Stay compliant while saving money—try Sterling Talent Solutions today!

Coming soon for AAA members: Employee Background Screening

Attention AAA members! The American Ambulance Association is teaming up with Sterling Backcheck, the country’s largest and best-respected employee background screening company. AAA members receive deeply discounted pricing, as all background checks for AAA members are treated as one “client.”

Contact for a fast free evaluation today!

(Learn more about the Sterling Backcheck difference.)

Maximizing VA Reimbursements on Emergency Conditions

Asbel Montes, AAA Payment Reform Committee co-chair and all-around reimbursement expert, recently developed some great quick tips on billing the US Department of Veterans Affairs for ambulance services.

Do you have a process in place to identify when a transported individual is a veteran being carried to a non-VA facility? In an emergency condition, it may prove very beneficial for you to have a consistent process within your billing department to ensure that you can identify these patients in order to maximize reimbursement, while also avoid billing the patient inappropriately… READ MORE►

downloadRead Asbel’s full article over on, or learn more in person at the upcoming June 9 AAA Regional Workshop in the San Francisco area!

The Case of the Disappearing ALS Assessment

by Brian S. Werfel, AAA Medicare Consultant | Updated May 2, 2016

Question: What do the Easter Bunny, the Loch Ness Monster, and a valid ALS assessment have in common?
Answer: Chances are, your Medicare contractor has never met any of them.

While it is clear that I don’t have a future in comedy, this joke illustrates an unfortunate reality: the contractors responsible for processing the ambulance industry’s claims routinely ignore an important aspect of the Medicare reimbursement regime.

The logical starting point for this discussion is to define what we mean by an ALS Assessment. In the Medicare world, the term “ALS assessment” has a very specific meaning. The regulations (42 C.F.R. §414.605) defines an ALS assessment as follows:

Advanced life support (ALS) assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient’s reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.

Over time, many in our industry has come to use the terms “paramedic assessment” and “ALS assessment” to be interchangeable. In certain contexts, the two are synonymous. However, for Medicare reimbursement purposes, they are not. In order to qualify as an “ALS assessment,” the regulation requires that the paramedic’s assessment be warranted based on the patient’s condition as reported to the dispatcher.

In other words, if the patient’s reported condition was such that an EMT-Basic would have been capable of properly assessing the patient, the situation would not qualify as an ALS assessment. That is true even if the ambulance service elects (or is required by local ordinance) to respond with a paramedic. It is only when the reported condition of the patient was of sufficient severity that an EMT-Basic would have been unqualified to conduct the assessment that the paramedic’s assessment rises to the level of an ALS assessment. That determination, in turn, must be based on established EMS dispatch protocols. (Multiple blog posts could be devoted to the issue of local dispatch protocols and their impact on Medicare reimbursement; however, for this blog, I want to keep the focus on the Medicare contractors.)

At this point, I imagine that many of you are asking yourself: why would the federal government create such a complicated (and inherently subjective) concept? Good question.

The best answer I can offer is to point to the reimbursement regime that existed prior to the implementation of the Medicare Ambulance Fee Schedule in 2002. If you recall, the previous reimbursement structure was based on the vehicle that responded to the patient. Provided the medical necessity requirement was met, the ambulance service would be entitled to bill for an ALS emergency regardless of the interventions (if any) that were provided by the crew. The Negotiated Rulemaking Committee (NRC) tasked with creating the Ambulance Fee Schedule agreed to move away from this vehicle-centric reimbursement regime to one based on the treatments furnished to the patient during the ambulance encounter. Under the new payment rules, the ambulance service would typically be entitled to bill for an ALS base rate to the extent they provided one or more valid ALS interventions.

To its credit, the NRC recognized that ambulance services frequently receive incorrect or incomplete information on the patient’s condition at the time of dispatch. For example, you may be told that the patient is experiencing chest pain, but the person that called 911 may be unable to provide information on whether the patient has an underlying cardiac condition, had suffered a traumatic injury, or may simply be experiencing indigestion. The NRC further recognized that a reimbursement regime that focused solely on the treatments provided to the patient might result in ambulance services electing to respond initially with a BLS vehicle, and only call for ALS backup once the EMT determined, on scene, that the patient was experiencing a serious medical emergency. To address this concern, the NRC created the ALS assessment to ensure that EMS organizations would be fairly reimbursed for the additional costs associated with responding with an ALS vehicle when the situation dictated.

So now that you have the background, let’s turn to how the ALS assessment is currently being interpreted by Medicare contractors. Put bluntly, to the extent they even acknowledge its existence in the regulations, they discount its significance. A recent guidance document by one of the Medicare Administrative Contractors illustrates the prevailing view among contractors:

“The ALS Assessment alone does not allow you to bill an ALS1 level of service…If the ALS Assessment has proven that an ALS transport is not medically necessary, it would only be appropriate to bill a BLS level of service.”

There are numerous problems with this statement. However, the MAC’s thinking on the subject is also illustrative of the larger problem with how they review emergency claims: specifically, the contractors frequently conflate the issues of: (1) medical necessity for the ambulance and (2) the appropriate level of service that can be billed.

The two must be separate determinations, if for no other reason than they focus on different points on the timeline of the patient encounter. The issue of medical necessity is determined by the patient’s on-scene condition. If that condition is such that other means of transport are contraindicated, the ambulance transport is medically necessary. Assuming the other requirements set forth in the Medicare regulations are met (origin/destination, patient signature, etc.), you would have a covered ambulance transport. By contrast, the ALS assessment focuses on the patient’s condition as reported to dispatch. As noted above, it focuses on whether that reported condition was such that an EMT-Basic was unqualified to conduct that assessment.

So, in the above-referenced statement, the MAC is incorrect in stating that you should bill for a BLS level of service when the ALS transport is not medically necessary. If the transport was truly not medically necessary (i.e., the patient could go safely by other means), it would not be covered by Medicare (at any level of service). In the same vein, when the MAC states that the ALS assessment does not allow you to bill ALS, it seems that they are confusing the term “ALS assessment” with the term “paramedic assessment.” By definition, a valid ALS assessment qualifies a medically necessary ambulance transport to be billed as an ALS emergency.

So how did Medicare’s contractors’ thinking get so convoluted? Based on numerous conversations with the policy folks at the MACs, I think the answer is they are simply misreading the regulation. Recall that the last sentence of the ALS assessment definition reads as follows: “An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.”

I think the MACs are interpreting the phrase “level of service” to mean “base rate.” On its face, this would appear to be a reasonable interpretation. However, a cursory review of the final rule that adopted the Ambulance Fee Schedule definitions makes clear that the phrase “level of service” refers to the interventions and/or treatments provided to the patient. For example, in that final rule, CMS stated that:

“An emergency ambulance trip may be paid as an ALS1-Emergency even when the only ALS service furnished is an ALS assessment.”

Words mean things. You have probably heard this phrase used numerous times. This is especially true when those words are being used by the federal government to control the distribution of millions of Medicare dollars. Many of the difficulties our industry is currently experiencing with Medicare could be avoided if CMS exercised a bit more care in its choice of language.

Have an issue you would like to see discussed in a future Talking Medicare blog post? Please write to me at

Spotlight: Jimmy Johnson

Jimmy Johnson
President, Life Emergency Medical Services
Immediate Past President, AAA Board
Enid, OK

Tell us a little about yourself.

I was born and raised in Frederick, OK – a small town in the southwest. I attended college for two years at Southwestern Oklahoma State University, and finished my last two years at Phillips University with a degree in Business Management. Throughout college I worked at Life EMS as an EMT, and in 1972 I was offered the opportunity to purchase half of the company from the original owner. A few years later, my partner sold the second half of the company to me.

I am a OU football fan, and I love to golf and to cook. I have a wonderful supporting cast in Pam and our three sons.

What do you enjoy most about your job?

The people I work with. I have this never ending respect for paramedics. They’re a highly skilled creature in a fairly small arena of medicine – cardiac issues, trauma, some pediatric emergencies. They’re as good as it gets. They may start an IV between a toilet and a bathtub, or between a bed and a wall, or in a ditch at 10 degrees below zero, or at a 104 degrees, or pitch dark, just the two of them. They don’t have the ancillary departments to call in, they don’t have respiratory therapy to call in and intubate the patient, they don’t have the lab to come in and start the IV. They do it all, and in many cases they do it with family members around that are distraught, and they have to handle that as well. I have unbelievable respect for them and what they do, and they are what keeps me coming to work every day.

What is your biggest professional challenge?

Probably the challenges of reimbursement – handling reimbursement cuts and budgeting. I am responsible for 40 employees and it can be very difficult to maneuver the waters of unending financial situations that we have no control over. Also, finding good paramedics is hard. I can hire a card-carrying paramedic any day of the week, but I would be doing a disservice to the rest of my people to let someone come in who is not clinically sound and may bring the integrity of the company down.

What is your typical day like?

When I arrive at the office, the first thing I do is make the rounds with every department – wish them good morning, see how they’re doing, and answer any questions they may have. I typically sit down and chat with the medics for about 20 minutes, just to see what is going on and how they’re doing. Then I get with the supervisors and we start working through any issues that we had the day before, and anything we need to work on, any projects, and get all of our in-house meetings out of the way. No two days are ever alike – something always pops up that you have to attend to.

I’d like to schedule myself to regularly go on more ride outs with my crews. It does two things – I get to monitor how we’re doing things out there in the field and it shows my staff that I care if I’m out there on their truck with them.

How has participation in AAA membership and advocacy helped your organization?

I can simply answer by saying that I probably would not still be in business had I not chosen to be involved in the American Ambulance Association. AAA has provided me with knowledge of what the environment is and how to negotiate it, and has given me the tools to manage my operation the way it should be managed. I really don’t know that I would have been able to successfully navigate the industry waters had it not been for the experiences and the exceptional mentoring that I’ve received with the AAA.

Explore AAA membership, or learn more about our advocacy for ambulance services across the country.

Savvik: Save Big on Grainger!

Check out the new contracts and specials from Savvik Buying Group’s contract with Grainger!

Savvik, formerly the North Central EMS Corporation (NCEMSC), was founded in 1997 as a nonprofit coop that negotiates best prices on millions of items ranging from fully-loaded ambulances to stretchers to office supplies to boots for individual employees.

Shop Savvik Now

Spotlight: Rebecca Williamson

Rebecca Williamson
Compliance Officer, Muskogee County EMS
Medicare Regulatory Committee Co-Chair,
AAA Board & Committees
Tulsa, OK

Tell us a little about yourself.

I was born in Muskogee, OK and currently live in Tulsa, OK. I received my nursing degree from Connors State College and my bachelor’s degree in English from Northeastern State University. I began working at Muskogee County EMS as a paramedic 24 years ago, have moved through the ranks over the years, and have held my current title of Compliance Officer for about 12 years. When I’m not doing EMS, I am the Director of Nurses at Kids’ Space, a child advocacy center in Muskogee.

I’m married to Steve Williamson, CEO/President of EMSA, and between us we have 7 children and 6 grandchildren.

What do you enjoy most about your job?

It’s always a challenge. Nothing is ever the same. I enjoyed being a paramedic because it was always different and no two patients were alike. Even though I’m now in administration and I’m dealing with Medicare, Medicaid, and insurance and regulatory issues and legislation, it is still never the same between days. I never feel like I have everything figured out, so there’s always a challenge in my job.

What is your biggest professional challenge?

The EMS industry as a whole has so many challenges, but my biggest professional challenge would be making sense of some of the laws, regulations and rules that govern how we operate and how we get paid. Also, dealing with the bureaucracy and taking a simple concept, such as “we provide medical care,” and trying to get people in Congress and the legislature to understand that we’re not a supplier, but a provider. Translating all of that into simple, real-world language that everyone can understand so we can all be on the same page – that is a challenge.

What is your typical day like?

I don’t really have a typical day! I’m very fortunate that, because I travel so much and because I have to be in different places, my schedule is very flexible and I’m able to work from home a lot. But typically when I go into the office, I can tell in the first five minutes if it’s going to be one of those days that I’m not going to sit down at all, or one of those days where I’ll have blocks of time to sit down and be productive. I try to talk to the medics every morning, and I talk to our Director and do a brief overview every morning and deal with any problems that may have occurred. My day is a constant interaction with the other administrators, the staff, and the medics, and can be a lot of running around.

How has participation in AAA membership and advocacy helped your organization?

I feel as though we as an organization (Muskogee County EMS) are light years ahead of so many other ambulance services because we get the information and the education that we need so easily. We can stay on the forefront of what is happening legislatively with Medicare and Medicaid regulatory issues, and we are in such a better position as a company and as a business because we have access to frontline information and top-of-the-line education. With AAA, industry experts are just a phone call or an email away. I cannot imagine trying to do my job and be effective at all without the education, the experts, and the ability to contact people who can help at a moment’s notice. I cannot imagine doing my job without having access to the AAA.

Spotlight: Jamie Pafford-Gresham

Jamie Pafford-Gresham
CEO, Pafford EMS
Co-Chair, AAA Government Affairs Committee
Hope, Arkansas, USA
Jamie’s LinkedIn

Tell us a little about Pafford EMS.

Pafford is a family business started by my parents in Magnolia, Arkansas in 1967 with just a station wagon! Some in the industry would call this a “Mom and Pop” organization, but my brothers and I now operate in four states nearly 100 ambulances with 550 employees, three helicopters, two fixed wing medical aircraft and a large billing company. We respond to 90,000 calls a year in 28 counties and parishes. Our corporate office is located in Hope, Arkansas.

Can you share with us a little about Pafford’s culture?

Communicating to our employees our philosophy and beliefs while living by the same set of rules strengthens their understanding of how important it is to us to practice what we preach.

[quote_right]Our mission statement comes from the Bible, and is very simple: Do unto others as you would have them do unto you.[/quote_right]Our mission statement comes from the Bible, and is very simple: Do unto others as you would have them do unto you. We teach our employees to think of each patient as a family member (one you like!) and treat them with the utmost care and respect. A verse I carry with me is Luke 10:33-34.

Because we have such a large service area, I see differences in stations and states; some it seems to be more driven by the local culture of an area. Overall, our Pafford family believe in our commitment to the communities we serve.

Do you have any tips for onboarding new employees?

Hiring quality candidates with the ability to excel in the company is very important. It is the beginning of a great relationship for both employee and employer.

[quote_left]New employees attend a series of training sessions with their field training officers that reinforce our company values.[/quote_left]New employees attend a series of training sessions with their FTOs (field training officers) that reinforce our company values. Unethical behavior is not acceptable. We are in the public eye and dealing with people’s lives, and our rules reflect our policy on such things with disciplinary action outlined in writing. Training and communication of the rules and regulations of our company is key for a successful outcome.

How do you retain employees?

We value each and every employee, and realize that they make sacrifices to be in this line of work. EMS is a very stressful job, with unusual and long hours away from family for shift work. It is also con unhealthy lifestyle with the eating on the go, not to mention the pay is not what most want but is dictated by federal programs that have limited revenues. I have the utmost respect for our crews, and that is one of the reasons that people stay—they realize that they are needed and appreciated.

The long and short of it is that you have to want to be in EMS, and you have to love what you do. The reward for most is the satisfaction of good patient care and positive outcomes, which bring them back to do more good work. We provide many benefits such as a caring environment with good benefits, good pay, and up-to-date equipment with a company that cares about their well-being.

What is your typical day like?

My job duties change from day to day—I wear many hats and the overall well-being of the company rests on my shoulders. (In case you haven’t noticed, I have really broad shoulders.) I am responsible to ensure we keep the communities we serve with the best EMS possible while maintaining proper finances company-wide.

Relationships are a huge part of any successful company, and are key to every executive. I can be found meeting with elected and public officials along with hospital administrators throughout our service area, communicating goals to our managers, and assisting with the billing company’s woes when needed. My husband, Ben, also works within the company, the ambulance discussions are never-ending!

I serve on many boards and commissions along with co-chairing the American Ambulance Association’s Government Affairs Committee.

How has participation in AAA membership and advocacy helped your organization?

I attended my first AAA meeting in 1984. I knew that day that there was something special about the group. The knowledge in the room, with so many diverse types helped me learn from some of the best minds in the country. I served on the board of directors for 15 years, and learned something new every meeting—still do today. To survive in this industry, you need to stay connected with change. The AAA is the way to go!

Savvik: New Vendor Buying Programs!

Check out the new contracts and specials from Savvik Buying Group! Savvik, formerly the North Central EMS Corporation (NCEMSC), was founded in 1997 as a nonprofit coop that negotiates best prices on millions of items ranging from fully-loaded ambulances to stretchers to office supplies to boots for individual employees.

Get started today, with great deals like these!


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AAA to Participate in 2016 EMS Strong Campaign

AAA is proud to announce its participation in the EMS Strong campaign during this year’s EMS Week. EMS Strong is a campaign that seeks to celebrate, unify and inspire the men and women of our nation’s emergency medical services. Learn more►

EMS Week will take place May 15-21, 2016. We’d love to hear how your organization plans to celebrate. Please fill out this brief form to share your story!


Share With Your Team: Taking Care of You

Taking care of yourself means paying attention to both your physical and your emotional needs. It means eating nutritious foods, getting enough exercise and sleep, and carving out time for activities you enjoy and people you care about. Here are a few tips and ideas to help you take better care of yourself.

  • Eat a healthy diet. There’s no question that the foods we eat affect how we feel and look. You don’t have to follow a strict diet, but it‘s important to follow a healthy diet. A nutritious, well-balanced diet gives you energy, protects against disease, and helps you maintain a healthy weight.One easy rule to follow is what some experts refer to as the “80/20 rule”: If 80 percent of what you eat is healthy — with a nutritious mix of fruits, vegetables, and whole grains — then you can let yourself eat what you want for the other 20 percent.
  • Avoid multitasking at mealtimes. If you always watch television at meals or eat on the run a lot, you may not realize how much you are eating. If you’re on the go a lot, keep healthy snacks in the car and eat a little while you’re out, then a little more once you get home. Avoid eating big meals just before going to bed.
  • Get exercise. People who exercise even moderately have much lower rates of heart disease and other medical problems, and regular exercise helps to reduce stress. But exercise is often the first thing to go when schedules get busy or during difficult times. Experts recommend that adults get a minimum of 30 minutes of exercise that makes you breathe harder on all or most days of the week.
  • Turn family time into exercise time. Try exploring a local park, going for a hike or bike ride, or just walking around the block with your family instead of going to the movies or shopping.
  • Stretch for just a minute or two when you wake up each day. In addition to helping you ease into your day, a brief stretching routine can restore or build flexibility and energize your body.
  • Get a good night’s sleep. Sleep experts say most adults need between seven and nine hours of sleep each night to be their best.  Sleep difficulties can take a toll on your health and well-being, especially if they persist. According to the Division of Sleep Medicine at Harvard Medical School, people who are sleep-deprived are more likely to experience poor concentration and irritability, have accidents, and even suffer from depression.
  • Establish a bedtime routine. Even adults need a bedtime routine. By adopting a routine and then sticking with it, you can train your mind and body to feel relaxed and ready to fall asleep when you start the routine. A bedtime routine can be as simple as listening to soft music, drinking a cup of herbal tea, or taking a bath and then turning out the lights at the same time every night. If you watch TV before bed, try not to watch programs that are violent or make you think too much, as it may then be difficult to turn off your brain.
  • Learn some relaxation techniques. Deep breathing and meditation are two of the most widely used relaxation techniques. To do deep breathing, try inhaling as you count to five slowly, and exhaling as you reverse the count. It may also help to relax each part of their body in succession, starting with the right foot, right leg, right shoulder, right hand, and so on, back down the left side.
  • Express your emotions. Talking with a trusted friend or writing in a journal can help you release strong feelings instead of keeping them bottled up, which can lead to more stress.
  • Do things that make you feel good. Whether it’s going to a movie, spending time with a relative or friend, or going for a walk, it’s important that you schedule time to do things that you enjoy and make you feel good so that you can cope with the pressures that cause you stress.

Want more ideas? Visit (username: theaaa; password: lifeworks) and explore our wide range of wellbeing resources, from a new podcast, Losing Weight Together! to articles like Taking Care of Yourself, and Getting Past Obstacles to Personal Change. You can also practice some of the guided exercises in our new Mindfulness Toolkit to help reduce stress and improve focus and well-being.

Call LifeWorks at 888-267-8126 or visit (username: theaaa; password: lifeworks). 

San Francisco Area Workshop at Paramedics Plus

A Comprehensive Compliance Strategy: How to Structure Your Billing Office for Integrity and Accountability

The Comprehensive Compliance Strategy One-Day Workshop is intended to provide guidance to Patient Accounts Managers/Supervisors and lead billing staff on the need for a comprehensive compliance strategy. The workshop provides a hands-on “Deep Dive” format that will allow for in depth discussion of your billing office operations. It is our goal to have attendees leave with actionable information on the reimbursement, compliance, and practical aspects of running a billing office. NAAC approved for 6.5 CEU hours.

$299 for individual members, $279 group rate (2 or more)
$599 for non-members, $579 group rate (2 or more)


Register Now


Paramedics Plus
575 Marina Blvd.
San Leandro, CA 94577

There is no event hotel for the workshop, however there are several hotels less than 5 miles from Paramedics Plus for those needing overnight accommodations.  Two noteworthy and affordable hotels nearby are:

The Marina Inn on San Francisco Bay
The Holiday Express at Oakland Airport





logo 8-2015



9:00 am –Welcoming Remarks and State of the Union

The first session will cover a current state of the industry as it relates to fraud and abuse in the ambulance business, CMS and OIG practices, investigative trends and the need for payment reform. The session will identify those fraudulent and unintended billing errors that led to action by the oversight agencies. Also, was it much to do about nothing? We will an update on the ambulance industry’s transition to ICD-10.

10:30 am- Deep Dive-The Lion in Sheep’s Clothing-Properly Vetting Employees

This in-depth session will teach you how to develop a comprehensive background screening process for all staff members, both new hires and existing staff, particularly those handling ambulance claims. Attendees will learn what screening they should be performing on employees and the law on when they can and should run credit reports on those in financially sensitive positions. Attendees will leave with a checklist and tips to ensure they accurately document their processes.

11:45am- Your Infrastructure- Establishing Partners Not Peddlers

An expose on establishing or improving upon vendor partnerships in the billing office, both from a compliance standpoint, as well as achieving the best type of partnerships for the EMS organization. The session will cover the use of indemnification clauses in the Business Associate Agreements, ensuring the vendor has a current Cyber Insurance Policy, out clauses for non-performance, GEO Screening for Vendor Employees (and their contractors!), and more. Then, the session will move into a larger scope for achieving the best value for the provider with advanced strategies like:  looking for partners, not peddlers, measuring net-back gain (vs. rate), using no obligation test files, comparing multiple vendor results, holding vendors accountable, interviewing negative and positive references, and more.

12:45pm –Deep Dive – Raising the Bar:Patient Accounts Policies & Procedures Workgroup

This interactive breakout session, facilitated by both speakers, will address the compliance concerns brought forward by the attendees. During this session, we will identify and discuss policies and procedures that will standardize ambulance billing office practices as part of a larger compliance plan. This session will give services a list of recommended Patient Accounts Policies & Procedures that will provide protection from unintended errors.

2:15 pm Billing Office Efficiencies, Managing Payor Problems and Your Revenue Cycle

Asbel Montes, with Acadian Ambulance will share some of his practical advice and step by step methods for having maximum reimbursement success.  From how to deal with VA claims, to how to make your data work for you, this is the session that will help you find solutions you can implement immediately.

3:45 pm Medicare Update

An invaluable overview of what you need to know regarding Medicare. Always pithy and delivered at a pace that holds your attention this session will give you the big picture for reimbursement. Brian will also cover court cases and the decisions that may surprise you. These real-life examples will help you avoid the common and not so common pitfall.

We’ll wrap up the day with Q&A with all our presenters



Scott Moore


Scott A. Moore, Esq. has been in the emergency medical services field for over 26 years.  Scott has held various executive positions at several ambulance services in Massachusetts.  Scott is a licensed attorney, specializing in Human Resource, employment and labor law, employee benefits, and corporate compliance matters.  Scott has a certification as a Professional in Human Resources (PHR) and was the Co-Chair of the Education Committee for the American Ambulance Association (AAA) for several years.  Also, Scott is a Site Reviewer for the Commission on the Accreditation of Ambulance Services (CAAS).   Scott earned his Bachelor’s Degree in Psychology from Salem State College and his Juris Doctor from Suffolk University Law School.  Scott maintains his EMT and still works actively in the field as a call-firefighter/EMT in his hometown.  Scott is a member of the American Bar Association, the Massachusetts Bar Association, the Society for Human Resource Management, and the Northeast Human Resource Association.

Brian Werfel

3Brian 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.

Tristan North


Tristan North serves as the Senior Vice President of Government Affairs for the American Ambulance Association (AAA). Mr. North is a registered lobbyist with more than 15 years of expertise and experience in government affairs. He joined AMG in 2002 and has been a lobbyist for the AAA since 1996. As the Senior Vice President of Government Affairs for the AAA, Mr. North oversees all aspects of the legislative and regulatory priorities of the Association before the Congress and Federal agencies. He is the lead lobbyist for the AAA and is responsible for shaping and implementing the public policy of the organization. Before joining AMG, Mr. North was Director of Government Affairs for the AAA at Hauck & Associates. Mr. North spent five years in the Government Affairs Division of Fleishman-Hillard representing the interests of health care and financial service clients before the Congress. For four of those years, Mr. North was a member of the Fleishman-Hillard team that represented the AAA on legislative and regulatory issues. Mr. North began his career in politics with the U.S. House of Representatives Committee on Financial Services where he worked as a professional staff member and investigator. While on the Committee, he was responsible for issues involving anti-counterfeiting efforts, the redesign of the currency and the review of the U.S. banking system. Mr. North graduated from Babson College in Wellesley, MA with a B.S. in Finance

Asbel Montes

Asbel Montes began his employment with Acadian in May 2009. He oversees Acadian’s revenue cycle management, contract management, business office process improvements, and government relations for state and federal reimbursement policy initiatives.

Over the past seventeen years, he has provided leadership in revenue cycle management to four ambulance agencies located throughout the Southeast.

Asbel has been a member of the American Ambulance Association (AAA) for eight years and has served on its Board of Directors; he has also served on the AAA’s Reimbursement Task Force. Asbel also sits on the board of the Louisiana Ambulance Alliance.

Brian Choate

2Brian’s diverse background consists of 18 years of finance, technology, and revenue cycle. His passion for out-of-the-box thinking and innovation creates a perfect storm for challenging the status quo. Brian’s start in revenue cycle began in 2009, when creating a technology that uncovers billable insurance(s) for misclassified self-pay accounts. Brian currently serves as faculty for the American Ambulance Association’s (AAA) Reimbursement Conferences,  and often speaks on reimbursement technologies at State and National EMS conferences.  When not working, Brian enjoys playing drums and spending time with his wife and three children, ages 17, 3, and 1.

Register Now
Please contact Desiree LaFont at or 703-610-9038 should you need any additional information.

GAO Issues Report on NEMT

The Government Accountability Office (GAO) issued a new report titled “Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States.” GAO was asked to review Nonemergency Medical Transportation (NEMT) under Medicare and Medicaid. This report examines 1) key features of NEMT services under Medicare and Medicaid and how these services are delivered; 2) steps CMS has taken to oversee NEMT under Medicare as well as Medicaid; and 3) the challenges that exist in providing NEMT under Medicaid and steps that selected state Medicaid agencies have taken to address those challenges. GAO recommends that the Secretary of the Department of Health and Human Services (HHS) direct CMS to assess current Medicaid NEMT guidance and update it as needed. HHS concurred with GAO’s recommendation and provided technical comments which were incorporated as appropriate.

MAC Novitas March 2016 Updates to Ambulance Services

On March 4, Novitas Solutions, Medicare Administrative Contract managers for several jurisdictions, asked AAA to share the following information with ambulance services.

March 4, 2016 – Letter to Ambulance Providers | March 4, 2016 – Letter to Beneficiaries

Jurisdictions Covered By Novitas

  • The Medicare Administrative Contract (MAC) Jurisdiction L (JL), which spans Pennsylvania, New Jersey, Maryland, Delaware and Washington D.C.;
  • The Medicare Administrative Contract (MAC) Jurisdiction H (JH), which spans Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, Mississippi, Indian Health Service (IHS) and Veterans Affairs (VA); and
  • The payment processing for the Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract, as authorized under Section 1011 of the 2003 Medicare Modernization Act.

Boustany (R-LA 3rd) Introduces the Timely Payment for Veterans’ Emergency Care Act

On March 3, 2016, Congressman Charles W. Boustany, Jr., MD, republican representative of Louisana’s 3rd district, introduced the Timely Payment for Veterans’ Emergency Care Act. According to data obtained by Boustany from the VA’s Chief Business Office, the VA has a nationwide emergency claims payment backlog of over $788 million.

When the VA fails to pay these medical bills on time, veterans’ credit ratings are put at risk.

Read more about Representative Boustany’s proposed solution on his website.

Share With Your Team: Substance Abuse Resources

Find out how AAA’s LifeWorks Employee Assistance Program, automatically covers all member organizations’ employees, can help your staff that is struggling with addiction.

Download our Substance Abuse PDF, then share electronically with employees. Articles covered include:

  • If You Suspect an Employee Has a Substance Abuse Problem
  • Recognizing a Substance Abuse Problem and What to Do
  • Drug and Alcohol Abuse: Warning Signs
  • Prescription Drug Abuse
  • Quick Facts About Alcohol Abuse
  • Support Groups for Family and Friends of Substance Abusers
  • What to Do If You Suspect a Co-Worker Has a Substance Abuse Problem
  • What is Reasonable Suspicion?
  • How to Help Someone Getting Past Resistance to Drug and Alcohol Treatment
  • Treating Addiction
  • How to Use the Employee Assistance Program
  • and many more!

Download Substance Abuse PDF

As always, you and your team can call our dedicated hotline, 1-800-929-0068, 24/7 to set appointments for FREE IN-PERSON COUNSELING in your area. Learn more on our AAA Employee Assistance Program page (membership required.)