Author: AAA Staff

Musings on 2014 Medicare Payment Data…Part 2

Brian S. Werfel, AAA Medicare Consultant

Every year, the Centers for Medicare and Medicaid Services (CMS) releases data on Medicare payments for the preceding year. The 2015 Physician/Supplier Procedure Master File (PSP Master File) was released in late November 2015. This report contains information on all Part B and DME claims processed through the Medicare Common Working File with 2014 dates of service.

In last month’s post, I focused on total Medicare spending. This month, I want to shine the spotlight on Medicare’s payment for ambulance transports to and from dialysis.

It is no secret that the federal government has long viewed dialysis transports with suspicion. In 1994, the HHS Office of the Inspector General (OIG) issued a report citing dialysis transports as an area of concern. In a 2013 report, the OIG cited the dramatic increase in the volume of dialysis transports since the implementation of the Medicare Ambulance Fee Schedule as evidence that the Medicare ambulance benefit is vulnerable to fraud and abuse. Dialysis transports were also featured heavily in the OIG’s 2015 report on questionable billing practices.  A 2013 report by the Medicare Payment Advisory Commission (MedPAC) noted that the utilization of BLS non-emergency transports, dialysis in particular, had grown faster than the utilization of other ambulance levels of service.

The Numbers Don’t Lie…

According to statistics provided by the U.S. Department of Health and Human Services, the population of ESRD patients increased by 85% from 2002 to 2011. Over that same period of time, the OIG noted that the number of covered ambulance transports to and from dialysis increased by more than 269%. In other words, while the ESRD population has grown steadily over time, an increasing number of those patients are transported to and from their dialysis appointments by ambulance.

Medicare payment data confirms this. In 2007, Medicare paid a total of $445.8 million for dialysis transports. In 2014, Medicare paid $717.1 million for dialysis, an increase of 60.86%. The increase is even more dramatic when you consider that Congress mandated a permanent 10% reduction in Medicare’s payments for dialysis transports furnished on or after October 1, 2013. Without that reduction, Medicare’s payments for dialysis would have been closer to $800 million in 2014, an increase of nearly 80%. Over that same period of time, total Medicare payments for ambulance increased by only 27.08%.

Between 2007 and 2014, Medicare’s payments for ambulance services increased by approximately $1.06 billion, with dialysis transports accounting for $354 million. In other words, approximately one-third of the total increase in Medicare spending on ambulance is attributable to dialysis.

If you focus only on BLS non-emergency transports, the impact of dialysis is even more striking. In 2014, Medicare paid $1.139 million for BLS non-emergency transports (not counting mileage). This is almost essentially unchanged from the $1.131 million it spent in 2010. However, during that same period, payments for BLS non-emergency transports to dialysis increased from $513.7 million to $558.4 million. Put another way, if you remove transports for dialysis, Medicare’s payments for BLS non-emergency transports (and non-emergency transports in general) actually declined over the past five years.

In its 2013 report on ambulance utilization, the OIG noted that dialysis transports had increased to 19% of all covered ambulance transports in 2011, up from 9% in 2002. Note: in 2014, dialysis transports had dropped to 17.1% of all covered transports, suggesting we may start to see the pendulum shifting back a bit.

Our industry may ultimately look back on 2013 as a tipping point. That year marked the first time that the total volume of BLS non-emergency transports to and from dialysis exceeded the number of BLS non-emergency transports to or from places other than dialysis.

But They don’t Tell the Full Story Either…

While the overall trend has been upwards, the increase in dialysis transports is not a national phenomenon. Rather, this increase is largely confined to a handful of states.

As noted above, Medicare’s payments for dialysis transports increased by approximately $45 million between 2010 and 2014. During that same period, Medicare’s payments for dialysis transports in New Jersey increased by $50.7 million. You read that right, if you exclude New Jersey, total Medicare payments for dialysis would have declined nationwide. If you have ever asked: “Why was New Jersey selected to be one of the initial 3 states for the prior authorization program?”, you have your answer.

Other states that saw significant increases over that period include:

State 2010 Dialysis Payments 2013 (2014)

Dialysis Payments

California $87.7 million $106.0 million
Georgia $25.5 million $69.9 million (2014)
Illinois $13.5 million $19.3 million (2014)
Louisiana $4.0 million $6.4 million
Michigan $12.7 million $17.5 million
New York $23.5 million $30.1 million (2014)
South Carolina $51.1 million $62.4 million
Virginia $25.3 million $30.2 million
West Virginia $7.9 million $9.9 million (2014)

If your state is not one of the ones listed above, chances are Medicare’s payments for dialysis are lower today than they were 5 years ago. This includes a number of states and/or territories that, historically, have been recognized as having a so-called “dialysis problem.” For example, total payments for dialysis have declined in Texas from $86.7 million in 2010 (itself a significant reduction from 2007) down to $53.8 million in 2014. This is likely the result of ongoing enforcement efforts in the state, including a moratorium on the enrollment of new ambulance providers. Pennsylvania, also selected to be part of the initial prior authorization program, saw payments for dialysis transports drop to $39.2 million in 2014, down from $62.6 million in 2010.

As I look at this data, two thoughts come to mind. The first is that, to the extent you agree that there is a problem with dialysis transports (and I am one of those that does), it is clear that the problem is largely confined to a handful of states.

The second is that our overall perspective on our industry may need to change. Traditionally, we have viewed the industry through the prism of “emergency” vs. “non-emergency.” And there are valid operations reasons to distinguish between these two categories. However, I can’t help but wonder if that worldview isn’t overly simplistic these days. Maybe we need to start viewing our industry as having three components, emergencies, non-emergencies, and dialysis.


 

AAA members, submit a Medicare question to Brian! Not yet a member? Learn more.

American Ambulance Association and Journal of Emergency Medical Services Announce Collaboration

Press Release

For Immediate Release

Contact

Amanda Riordan
Membership Director
American Ambulance Association
703-610-0264
ariordan@ambulance.org
www.ambulance.org

A.J. Heightman, MPA, EMT-P
Editor-In-Chief
Journal of Emergency Medical Services
858-638-2605
aheightman@pennwell.com
www.jems.com

Baltimore, MD, February 25, 2016 – The American Ambulance Association (AAA) and the Journal of Emergency Medical Services (JEMS) today announced a collaboration to bring robust content and educational offerings to AAA members in the emergency medical services (EMS) and medical transportation industry.

AAA members will now receive complimentary access to EMS Insider gated content covering key EMS topics for top-level decision-makers. Additionally, JEMS will provide in-depth journalistic coverage, as the exclusive media partner, of AAA’s events and initiatives, including the Stars of Life EMS personnel recognition program.

“We are excited to bring innovative EMS Insider content and high-quality event coverage to our members,” said American Ambulance Association executive vice president Maria Bianchi. “We look forward to working with the JEMS team to shine light on the AAA Stars of Life who do so much for their communities.”

JEMS is pleased to collaborate with the American Ambulance Association,” said A.J. Heightman, editor-in-chief of JEMS and EMS Insider. “AAA members are EMS leaders, and we look forward to providing additional content that will support their efforts to provide expert care to patients while driving operational excellence.”

To kick off the partnership, AAA will exhibit at EMS Today Conference and Exposition|The JEMS Conference 2016 in Baltimore, February 25–27, accompanied by top leaders from the member community. JEMS will in turn serve as the official media partner of AAA’s Stars of Life in Washington, D.C. April 11–13, bringing fresh visibility to the EMS heroes honored there. The collaboration will carry through the 2016 AAA Annual Conference and Tradeshow and EMS Today Conference and Exposition|The JEMS Conference 2017 in Salt Lake City, UT, with additional content and networking opportunities for AAA members to be developed over time. “This is just the beginning,” said JEMS’s A.J. Heightman.

About the American Ambulance Association (AAA)

Founded in 1979, the American Ambulance Association represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. AAA’s advocacy, member resources, educational offerings, and publications support excellence in pre-hospital care, an essential part of the public healthcare system. www.ambulance.org

About the Journal of Emergency Medical Services (JEMS)

As “The Conscience of EMS,” JEMS leads the industry in providing the EMS advanced provider, instructor and administrator with clinical breakthroughs, product reviews, continuing education and more. JEMS is backed by the strength of PennWell, a media and information company with 130 print and online magazines and newsletters, 60 conferences and exhibitions on six continents, and an extensive offering of books, maps, websites, research products, digital media, and database services. www.jems.com.

About PennWell Corporation

Founded in 1910 in Tulsa, Oklahoma, PennWell Corporation is a privately held and highly diversified business-to-business media and information company that provides quality content and integrated marketing solutions for the following industries:  Oil and gas, electric power generation and delivery, hydropower, renewable energy, water and wastewater treatment, waste management, electronics, semiconductor manufacturing, optoelectronics, fiber-optics, aerospace and avionics, LEDs and lighting, fire and emergency services, public safety, and dental.

PennWell publishes over 130 print and online magazines and newsletters, conducts 60 conferences and exhibitions on six continents, and has an extensive offering of books, maps, websites, research and database services.  PennWell Public Safety, a PennWell business located in La Jolla, CA, produces public safety products and services including JEMS (Journal of Emergency Medical Services), JEMS.com, Law Officer Magazine, EMS Today Conference and Exposition, LawOfficer.com and other products.

In addition to PennWell’s headquarters in Tulsa, Oklahoma, the Company has major offices in Nashua, New Hampshire; London, England; Houston, Texas; San Diego and Mountain View, California; Fairlawn, New Jersey; Moscow, Russia; and Hong Kong, China.  www.pennwell.com

– END –

Spotlight: Kim Godden

Kim Godden
Vice President of Legal and Government Relations
Superior Air-Ground Ambulance Service (Michigan, Indiana, Illinois)
Region 3 Alternate, American Ambulance Association Board
Elmhurst, IL

Tell us a little about yourself.

I grew up in Barlett, Illinois, a Chicago suburb. I received my BA in History and Political Science from Purdue University and my law degree from DePaul University College of Law.

After graduating from Purdue, I worked for the Illinois Attorney General’s Office while attending law school in the evening. While with the Attorney General’s office, I was an policy analyst/attorney for criminal justice and victims’ rights initiatives. During this time, I reviewed, drafted, and testified on various legislative and regulatory initiatives.

In 2007, I was able to bring this experience to the ambulance industry when I joined Superior. In addition to sitting on the AAA board, I also sit on the boards of the Illinois State Ambulance Association and the Indiana EMS Association. I also participate on the government affairs committee for the Michigan Association of Ambulance Services.

In addition to overseeing government relations and regulatory and compliance matters for Superior, I oversee the legal department which manages litigation, contracts, real estate and employment matters.

Kim with her family.
Kim with her family.

I have been married to my husband, Nick, for 16 years and we have two daughters, Hannah (8) and Amelia (6). As for hobbies, kids and work keep me busy, however, when I have a chance, I enjoy running and reading (not at the same time).

What do you enjoy most about your job?

I enjoy problem-solving and advocating for such an amazing industry. The ambulance industry is often overlooked and misunderstood. EMS providers are busy caring for patients, therefore, we rarely have time to create awareness and support for our industry – I get to beat the drum for private EMS!

What is your biggest professional challenge?

My biggest challenge is changing the perception that private industry isn’t as good or worthwhile as public agencies. There is a misconception that because a company is for-profit, their goals, mission, and level of compassion differ from those of a public or nonprofit entity. Superior employs over 2000 dedicated, devoted EMS professionals—whether caring for patients, working in dispatch, or managing the back office, our entire team is dedicated to bringing the best care and customer service to our patients.
[quote_right]Superior employs over 2000 dedicated, devoted EMS professionals—whether caring for patients, working in dispatch, or managing the back office, our entire team is dedicated to bringing the best care and customer service to our patients.[/quote_right]

What is your typical day like?

Every day is different due to travel and attendance at various meetings. On a typical day, I try to drop my daughters off at school at 8:30 and I am in the office by 9:15. Usually the day is filled with meetings and conference calls on a myriad of topics, with the constant interruption of emails that need attention and various “walk-ins” for legal consultation. No two days are the same, which I enjoy. I am usually home by 7:00 p.m., and after bedtime stories, I am back on the computer responding to the day’s emails or catching up on reading. My 2016 resolution is to unplug and try to leave work at work, but we all know that EMS is a 24-hour business, so I won’t be 100% successful and it will occasionally follow me home.

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

As we know, with advances in healthcare, people are living longer, and there is frequent need to move patients between nursing facilities and hospitals. We have also seen the advent for advanced level care for patients. Most inter-facility transports involve the discharge of a patient back to a nursing facility, or moving a patient from one facility to another for specialized care. Superior and our colleagues who provide these services are an important part of EMS and the overall continuum of care.

Our organization performs a high percentage of inter-facility transports, and being able to advocate and share the perspective of an agency who performs this discipline has been worthwhile not only to Superior, but to the industry as a whole. Being able to discuss with other providers our shared and differing challenges is important as we craft regulations for the future.

I enjoy working with my fellow board members and AAA staff. We don’t always agree, however we respect one another’s opinions and in the end, this leads to better policy and advocacy for our industry.


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

EMSA Welcomes Congressman Jim Bridenstine

Long-time AAA member the Emergency Medical Services Authority (EMSA) of Oklahoma welcomed Congressman Jim Bridenstine (R-OK, District 1) for a tour today. Thanks to Angie Lehman, EMSA’s Vice President of Financial Services and co-chair of the AAA Medicare Regulatory Committee for sharing these great photos from the visit.



As always, AAA encourages member organizations to open their doors to legislators to showcase the critical importance of prehospital care. If you give a tour or overview to a congressperson, please share your photos with us!

Share With Your Team: Building Resilience

(from the AAA Employee Assistance Program powered by Ceridean LifeWorks)

All of us face unexpected changes, challenges, and set-backs at some point throughout our lives. How can you learn to keep up a positive attitude and stay strong through life’s unwanted changes and challenges? Here are a few resilience techniques to practice and to help you get through challenging times:

  • Choose to have a positive attitude. There are many things over which you have no control — for example, you can’t control whether the company gets sold and you lose your job. You can’t control whether your child is faced with a serious illness. But you can choose how you respond to the difficulties and setbacks you face.
  • Take care of yourself. The stronger and fitter you are physically, the more resources you will have to face the challenges that life brings you. Practice healthy habits. Make sure you get enough rest, eat a healthy diet, get regular exercise, get out and walk alone or with a friend, and manage feelings of stress. The more you do for yourself, the more resilient you’ll feel during times of challenge and change.
  • Use “traffic light coping.” This exercise, developed by Dr. Williams, works like this: When you start to feel worried, panicked, or angry — when you start to “see red” — stop and relax. Pause. Take some time to breathe deeply to help calm your body and mind. Soften your shoulders. Let your muscles soften slightly. When you feel calmer, you’re ready to move forward.
  • Trust your inner strength. Experts agree that we have strengths we never knew we had until we have to use them. You’ll be amazed at how many personal resources you have that you never even knew about. Remember that change can lead to personal growth.
  • Start with a single step. If you are faced with a challenge that feels big or overwhelming, start with the simplest thing you can do that takes you in the direction you want to be. Ask yourself, “What’s the smallest thing I can do to get started?” Once you’ve thought about it, do it.
  • Let go of your anger. A difficult challenge can cause us to feel angry and upset. These feelings are normal, but they won’t help us move forward. Work through your anger by writing about it, or talking about it with a trusted friend. Try to let go of negative feelings. It’s not easy to do. It takes practice and work. But try. You’ll be amazed at the results.
  • Focus on solutions, not problems. Instead of focusing on what you feel you may be losing, consider what you may gain because of the change. For example, if your job is changing, this may be the opportunity you were waiting for to reassess your work and find new direction.
  • Laugh. Even when things seem to be falling apart around you, try to find time to smile and laugh. It’s very healing and it will help you forget your worries for a few moments. Rent a movie that makes you laugh or spend time with a friend with a good sense of humor.
  • Focus on the things that are good in your life. Count your blessings. Try to appreciate the day-to-day good things in your life now. The more time you spend doing that, the more energy you will have to deal with the problems that you face. A sense of gratitude helps put things in perspective.

For more ideas on staying resilient during times of change, get in touch with LifeWorks—call to speak with a caring, professional consultant anytime, 24/7. You can also go to www.lifeworks.com to explore our online resources including an award-winning booklet, Bouncing Back: Staying resilient through the challenges of life , a recording, Navigating Workplace Change featuring stories and ideas on how to thrive in turbulent times. You can also check out helpful articles like Ten Ways to Bounce Back and Finding Strength in Family and Community, or a podcast, Adjusting to Changes in Your Personal Life. LifeWorks is completely confidential and it’s provided to you at no cost through your organization’s AAA membership.

Call LifeWorks at 800-929-0068 or visit www.lifeworks.com (username: theaaa; password: lifeworks). 

Spotlight: Jerry Glass, Labor Relations Expert

Jerry Glass
President
F&H Solutions Group
Download Jerry’s vcard
Follow Jerry @JerryGlass
Connect with Jerry on LinkedIn

Tell us a little about yourself.

I was born and raised in New York City. I went to college at Boston University and then moved to Washington, D.C., to attend George Washington University, where I received my master’s degree. It is also where I met my wife, Karen. We have been married for 36 years, but with all the travel I do, I tell people we have only been together for about 15 years! We have two adult children and one son-in-law.

My number one passion is basketball. I live and breathe the sport. I have been playing in a basketball league and enjoying pickup games with a group of guys for more than 30 years. And if you invite me to see a high school, college, or professional basketball game, count me in. Karen and I also love cycling and spinning. We take a cycling trip each summer and have seen some great sites on our bikes.

How did you get into labor relations? Can you give us some background on your professional life?

When I graduated from GWU, my first job was with the Veterans Administration as an analyst. The job required a lot of travel and was really gut wrenching, working with our veterans who had done so much for our country. From there, I worked as a costing/financial analyst for the American Association of University Professors (AAUP) which is a trade association and a union. Then, I moved to the Airline Industrial Relations Conference, which served as the labor policy organization for the U.S. scheduled airlines. I started out as the Director of Labor Relations Research and was promoted to Executive Director and Vice President. After 9 years in that job, I went out on my own as a labor and employee relations consultant. The rest was history as I built my consultancy into a national labor relations and HR consulting firm, F&H Solutions Group.

In addition to running my firm, I also served as the Executive Vice President and Chief HR Officer at US Airways during the airline’s two bankruptcies. Wow, did I learn a lot about restructurings! Thankfully, the airline not only survived, but eventually became part of the largest airline in the world.

I have been fortunate to have an amazing team working with me. Together, we provide labor relations advice and negotiations expertise to many of the most important industries in the country, including transportation, construction, property management, media and more.

How have you seen labor relations issues impact business?

[quote_right]”People involved in labor relations must be great communicators and even better listeners.”[/quote_right]Employees are a huge part of an organization’s success. When unions represent employees, it adds a level of complexity to how you manage employees. People involved in labor relations must be great communicators and even better listeners. Labor relations has an impact on a company’s bottom line and it is crucial for employers to tread carefully, work cooperatively, and be proactive when dealing with unions.

How can FHSG help AAA members with their labor relations issues?

We would like to help members understand the dynamics involved in labor-management relations. Whether it’s learning how to communicate effectively with unionized employees, providing research on CBAs in the industry, or understanding the different aspects of a union campaign, we can help you devise a labor strategy. We will offer a free initial consultation to all AAA members. In addition, we will provide insightful blogs and webinars on topics related to labor relations, proactive employee relations and leadership/managerial skills.

Any parting thoughts or last words?

While it is not uncommon for management at newly unionized companies to feel intimidated, it is crucial that management continue to do their jobs and effectively manage employees. Over time, you will learn to work with the union and how to maintain a positive, inclusive and safe workplace culture for your employees. Management cannot allow union activity to disrupt the ability to manage and ensure the integrity of the day to day operation.

WTAE Shows 25% of Ambulance Calls Unpaid

WTAE Pittsburgh’s Action News recently published a great video investigative piece by Paul Van Osdol on the realities of ambulance funding.

So who pays for these and other non-transport calls?

“The folks that go to the hospital end up paying for the 25 percent that we don’t transport,” Porter said.

But even that does not cover the entire cost, and as a result, ambulance companies are hurting.

A survey of Allegheny County EMS services found 75 percent of them are losing money. On average, they collect only 43 percent of the amount they bill.

“That is frightening when you think about the EMS system as a whole,” Porter said. “The risk is burnout of EMS crews, overworked EMS crews, delayed response time, inadequately trained staff.”

Read the full article, and see their fantastic video, over at WTAE.com.

Watch Now

Chicago Regional Workshop at Superior Air-Ground Ambulance Service

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)

NAAC_CEU_CAC_CACO_LogoVector

REGISTER NOW

Location:

Superior Air-Ground Ambulance Service
395 W Lake St
Elmhurst, IL 60126
Recommended hotel: SpringHill Suites, Elmhurst/Oakbrook

THANK YOU TO OUR EVENT SPONSORS

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logo 8-2015

 

PROGRAM AGENDA

9:15am 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.

10:45am 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 that they can use at their own services to ensure that they properly document their processes.

12:00pm- Your Infrastructure: Establishing Partners Not Peddlers

Our noon session is 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.

1:15pm 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.

3:00pm Medicare Update and Court Cases You Need to Understand

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.

REGISTER NOW

ABOUT OUR PRESENTERS

Scott Moore

2

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.  In addition, 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

1

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. Prior to 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

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 if you would like additional information for this event. dlafont@ambulance.org or 703-610-9038

Share News Stories and Press Releases with AAA

AAA members, do you have a great news story or press release to share with fellow members? We’d love to help. Submit links to content published on non-AAA sites below.

  • News articles may be included in the AAA Digest e-newsletter and/or blog.
  • Press releases are accepted as they relate to heroism, community service, merger and acquisition announcements, and other noncommercial activities. Please note that commercially-focused or product-specific press releases cannot be shared by AAA as a matter of policy.

Stories can be about your ambulance service, your employees, services near you, policy, or other topics that you feel may be of interest to other members. Thank you for sharing your stories with us!

Would you like to write or speak FOR AAA? Read more.

Please note that AAA reserves the right to decline to publish any content for any reason. Only AAA members are eligible to submit content.

  • Submitter Name
  • Link to the content you are submitting for consideration. Note: AAA can't accept Word doc or PDF press releases—please post press releases to your site, then submit the link.
  • Article or press release title
  • Date the article or press release was published
    Date Format: MM slash DD slash YYYY
  • For news articles, include the name of the newspaper, radio station, magazine, etc. For press releases, note the name of the website where this is published (PR Newswire, your organization's website, etc).

AAA Members Save on EMS Today!

In 2016, AAA is working closely with the Journal of Emergency Medical Services (JEMS) to bring members even more high-quality educational opportunities.

As such, we are proud to offer members a special Buy-One, Get-One discount on Gold Passport registrations to the upcoming EMS Today conference in Baltimore, February 25–27. Register for a Gold Passport with code AAA before February 12, and you will receive a code for a free Gold Passport to share with a friend!

Learn More

EMS Today (a JEMS conference)
February 25–27, 2016
Baltimore Convention Center

Join an AAA Committee! (Deadline Feb 4)

The American Ambulance Association is driven by the passion and commitment of its volunteer leaders. Have you considered becoming a member of one of our committees? If so, please submit the form below to apply. Committee chairs will receive the list of interested parties on February 5, and new members will be notified by the end of February.

Thanks so much for considering sharing your time with fellow AAA members.

Committee Interest

Please indicate your interest in working on an American Ambulance Association committee by filling in the form below. *Please note that there is a maximum of two employees from a single company on any individual committee.
  • This field is for validation purposes and should be left unchanged.

New York City Regional Workshop

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)

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Location:

Akin Gump Strauss Hauer & Feld, LLP
One Bryant Park
Bank of America Tower
New York, NY 10036-6745

An event hotel is not being utilized for this event. However, there are a number of affordable hotels, as well as unique boutique hotels, within walking distance of the Akin-Gump Offices. The Akin-Gump offices are less than 1 mile from both Grand Central and Penn Stations.

CONTENT SPONSORED BY:

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PROGRAM AGENDA

9:15am –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.

10:45am- 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 that they can use at their own services to ensure that they properly document their processes.

12:00pm- Your Infrastructure- Establishing Partners Not Peddlers

Our noon session is 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.

1:15pm –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.

3:00pm Medicare Update and Court Cases You Need to Understand

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.

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ABOUT OUR PRESENTERS

Scott Moore

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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.  In addition, 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

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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. Prior to 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

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.

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Please contact Desiree LaFont if you would like additional information for this event. dlafont@ambulance.org or 703-610-9038

HUD Program Gives 50% Mortgage Discounts to EMTs & Paramedics

Are you familiar with the Department of Housing and Urban Development’s Good Neighbor Next Door program? Please share this with your medics, if you haven’t already.

Good Neighbor Next Door

Law enforcement officers, pre-Kindergarten through 12th grade teachers, firefighters and emergency medical technicians can contribute to community revitalization while becoming homeowners through HUD’s Good Neighbor Next Door Sales Program. HUD offers a substantial incentive in the form of a discount of 50% from the list price of the home. In return you must commit to live in the property for 36 months as your sole residence.

How the Program Works

Eligible Single Family homes located in revitalization areas are listed exclusively for sale through the Good Neighbor Next Door Sales program. Properties are available for purchase through the program for seven days.

How to Participate in Good Neighbor Next Door

Check the listings for your state. Follow the instructions to submit your interest in purchasing a specific home. If more than one person submits an offer on a single home a selection will be made by random lottery. You must meet the requirements for a law enforcement officer, teacher, firefighter or emergency medical technician and comply with HUD’s regulations for the program.

HUD requires that you sign a second mortgage and note for the discount amount. No interest or payments are required on this “silent second” provided that you fulfill the three-year occupancy requirement.The number of properties available is limited and the list of available properties changes weekly.

To learn more, please see our Good Neighbor Sales Frequently Asked Questions!

Spotlight: Mark Postma

Mark Postma
Vice President, Paramedics Plus
President-Elect, AAA Board
Chair, Commission on Accreditation of Ambulance Services (CAAS)
Largo, Florida, USA

Can you please tell us a little about yourself? How did you come to work in EMS?

I grew up in a small town outside Sioux Falls, South Dakota, and obtained my EMT license at age 16. I became a paramedic in 1984 and began working in Davenport, Iowa at MEDIC EMS. After working there for 20 years and becoming Executive Director, I began at SUNSTAR Paramedics in 2004. I am the COO for SUNSTAR and Vice President of Paramedics Plus operations (Sioux Falls, Fort Wayne, and Oakland).

I have been married 31 years to my great wife, Lisa. I have two children: Delaney, a registered nurse at Florida Hospital in Orlando; and my son, Parker, a sophomore at the University of Florida. My hobbies are basketball, boating, and IndyCar Racing.

What do you enjoy most about your job?

It is very diverse. As the Vice President, I really oversee daily operations and have great people who work for me. They are local and report out how things are going, daily achievements and challenges.

Paramedics Plus/ETMC is a great organization and is focused on providing great care over financial constraints. I work for a great boss, Ron Schwartz, who fully understands the industry and its daily challenges. We are both from the Midwest and work together on issues.

What is your biggest professional challenge?

Sometimes it is just a challenge wearing my CAAS Chairman hat, AAA hat, SUNSTAR hat and Paramedics Plus hat. Everyday you have to decide which issues need to be the priority. Just glad I own an iPad and have a great staff!

What is your typical day like?

I wake up at 0500 eveyday and read emails and try to read at least 2 newspapers. After that, I run 2-5 miles depending on my schedule. The only days I take off are travel days.

After getting to work or on an airplane, it is interacting with staff until our daily PULSE meetings. Most afternoons are teleconferences from all of our operations or AAA meetings.

I go to lunch with my staff every day whether I am in Pinellas or one of the other operations. Evenings are usually laid back, but the weekends are boating and basketball. I am usually in bed at 9:00 pm!

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

I have been very involved with the Commission on Accreditation of Ambulance Services (CAAS) as the representative for the AAA for the past 20 years. I am currently the Chairman of the Board and have enjoyed the AAA/CAAS relationship.

Transitioning to the AAA President will have its challenges as it is a huge responsibility. The AAA represents EMS in America, and I would like to see members embrace our organization as the “”go to”” organizations for challenges in our industry.

The AAA membership and advocacy is immeasurable in how it helps our organization every day!

Van Arnam Retires From AEV, Will Head CAAS GVS

Mark Van Arnam, founder and CEO of American Emergency Vehicles, has announced his retirement from the North Carolina based manufacturer of ambulances. “It is extremely difficult to leave AEV,” stated Van Arnam. “But, the company is performing well, and is run by a strong team.” Mark has been in the ambulance business for over 45 years, and is looking forward to some new challenges.

First on his list of projects is the implementation of the new Ground Vehicle Standard (GVS v.1.0), scheduled to be published in February by the Commission on Accreditation for Ambulance Services (CAAS). “Our broad based GVS committee spent over two years developing this new consensus standard for ambulances,” stated Van Arnam, who served as Vice Chair of the Committee. “We are very proud of our document, and anxious to roll it out as a successor to the KKK-A-1822 standard which the US Government will sunset in the near future.”

CAAS is an ANSI accredited organization that defines the “gold standard” for operations in the medical transportation industry. “CAAS is very excited about the Ground Vehicle Standard project,” stated Mark Postma, CAAS Chair. “We have now created the gold standard for emergency medical vehicles, intended for use by all types of providers in the broad spectrum of EMS.”

Postma went on to say “CAAS is proud to appoint an industry leader like Mark Van Arnam to serve as Administrator for the inaugural era of the GVS. We look forward to seeing the CAAS GVS standard become the new cornerstone for emergency vehicle production and certification throughout North America.”

For additional information:

www.groundvehiclestandard.org
www.caas.org

Spotlight: Asbel Montes

Asbel Montes
Vice President, Acadian Ambulance Service, Inc
Lafayette, Louisiana, USA
Follow Asbel on Twitter at @asbelmontes
Asbel’s LinkedIn

Can you please tell us a little about yourself?

I was born in San Bernardino, CA and lived there until I was five. My dad was in the Air Force. When I was five, he felt the call to become a pastor in North Carolina and was discharged from the Air Force.

I am married and have one daughter who is fifteen years old.

I have played the piano since I was eight years old and used to be the music minister for my dad and my brother-in-law, until my career became too demanding to do both.

I am an avid read of non-fiction and fiction. I enjoy a great political or legal thriller.

How did you come to work in the industry? How long have you been involved?

I started in the ambulance industry at the age of 21. I answered an ad in the newspaper for an account manager position for an ambulance billing company in North Carolina. I have been in the revenue cycle space for almost 19 years.

What do you enjoy most about your job?

I enjoy the people I work with at Acadian. Acadian Ambulance Service has a culture where the employees truly care about the success of the company. This culture is prevalent throughout the organization from senior leadership to front-line staff.

What is your biggest professional challenge?

My biggest challenge is the federal and state regulations that continue to negatively impact our industry from Medicare, Medicaid, and insurance companies. This has a downstream effect on increasing our cost per claim due to the excessive administrative burden, as well as reducing our revenue per transport.

What is your typical day like?

My day starts at 4:45 am. I like to meditate and read for about an hour before getting to the office by 7:00 am. My day is packed with meetings and typically culminates with me leaving the office around 6:00 pm.

I travel extensively between Austin, Baton Rouge, and Washington, DC.

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

The American Ambulance Association has been beneficial in helping to create a united front in the ambulance industry for important initiatives on Capitol hill.

VIDEO: AAA Experts in Reimbursement, Regulations, Human Resources, Operations

Did you know that your AAA membership includes access to some of the top minds in the ambulance industry today? As the healthcare landscape becomes ever more complex, it’s nice to know you have experts on your side.

Watch the video below to learn more about the attorney-consultants that AAA retains in order to ensure our member organizations are ahead of the curve on human resource, reimbursement, legislative, and regulatory issues.

Attention, AAA Members!
Have a question? Submit it to our experts today!
Ask a reimbursement or Medicare question.
Ask a human resources or operations question.

Not yet a member? Join today to gain access to AAA experts, plus a wealth of other powerful member benefits.

Savvik 10 Minute, 10 Item, 10% Savings Challenge

Savvik Buying Group, formerly North Central EMS Cooperative, is offering AAA members the opportunity to save even more on their first orders for Henry Schein medical supplies. Read below to learn more!

10 ITEM – 10 MINUTE – 10% CHALLENGE!

Give Savvik 10 items and 10 minutes of your time, and we will help you save money!
Pick the 10 med supply items that you use the most and we will share with you our Savvik national contract price. We will do all of the comparison work! We will even give you an extra 10% discount* on top of our already low contract price on your first order with our medical supplies provider Henry Schein. No minimum purchase requirement, no long term commitment, no freight charges orders of $150.00 or more.

Start the new year saving money!

Email Savvik Your Top 10 Items!

Good for new Henry Schein customers only thru January 31st 2016. *10% discount offer on first orders not to exceed an order total of $10,000.

10 Safety Topics that Will Move EMS Forward in 2016

What are your ambulance services’s safety priorities for 2016? AAA member The Center for Patient Safety has just released 10 Safety Topics that Will Move EMS Forward in 2016, a free download covering:

  • Airway Management
  • Behavior Health Encounters
  • Crashes: Ambulance and Helicopter
  • Device Failures
  • Medication Errors
  • Mobile Integrated Healthcare
  • Pediatric Patients
  • Safety Culture
  • Second Victim Intervention
  • Transition of Care

Get your copy today to learn how to ensure safety for your employees and patients.

Download Now

Spotlight: Ron Thackery

Ron Thackery
AAA Professional Standards Committee Co-Chair
Senior Vice President Professional Services
American Medical Response
Greenwood Village, CO

Can you please tell us a little about yourself?

I grew up in Wichita, KS and lived there until I graduated from high school. Most of my siblings still live in Wichita. I moved to Memphis and attended Christian Brothers University for undergraduate and taught high school for five years. I went to night law school at the University of Memphis and practiced in-house for 10 years. I have two children, Conor (31) and Kaitlin (29), who live in Memphis. Conor is an auto mechanic and Kaitlin teaches high school English. My wife, Diane, is a nurse in the operating room at Sky Ridge Hospital in Denver. I love to play golf – fortunately Diane does as well. She and I also ride road bikes and last summer took a biking vacation in the Piedmont area of Italy.

How did you come to work in the industry? How long have you been involved?

I have worked in EMS for 20 years. I am not a clinician. Previous to AMR, I worked as in-house counsel at Federal Express. I knew someone from FedEx who worked at AMR and he recruited me to take a position with AMR when they moved their corporate headquarters from Boston to Denver. I have learned plenty about EMS and have had the privilege of leading national functions in safety, risk management, fleet and real estate.

What do you enjoy most about your job?

I have a wide variety of duties and it is not uncommon for issues related to any of those matters to rise to the top of the to do list each day. While that presents challenges to planning, it creates opportunities to engage with people and processes that are rewarding. I do like AMR and Envision HealthCare and have been very fortunate to be part of those companies. They have enabled me to grow professionally, learn to lead others and engage in activities that enhance EMS. It seems that I work all the time because I enjoy the challenges it presents.

What is your biggest professional challenge?

I am an advocate for safety of patients, caregivers and the general public. Great headway has been made through research with regard to ambulances, stretchers, exposures, etc. More research on fatigue and EMS safety will continue in the next few years. The challenge is finding the most efficient process to introduce, influence and implement these solutions for private EMS providers.

What is your typical day like?

I maintain a running list of TO DO items and focus on completing those as time permits. I travel a few weeks each month across the country. I meet with EMS operators and caregivers, I work on many facets of safety and claims, I work strategically to influence standards, I communicate with other leaders in the organization to keep them aimed in a common direction. My days are relatively planned with the flexibility to address matters that arise each day. I try to stay out of the way of things that need to be done and are best led by others, and simply provide support for those efforts.

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

AAA is the glue that enables EMS operators to focus on issues of importance. AAA allows EMS operators to collectively pursue strategies to enhance the industry. AAA has enabled AMR to advance safety initiatives before national associations and regulatory agencies.