Preliminary Estimate of 2018 Medicare Rates

A Preliminary Estimate of 2018 Medicare Rates In this blog, I will provide a preliminary estimate of the Ambulance Inflation Factor (AIF) for calendar year 2018.  The AIF is main factor that determines the increase (or decrease) in Medicare’s payment for ambulance services. Calculating the 2018 AIF The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year. For 2018, this means the 12-month period ending on June 30, 2017. Starting in calendar year 2011, the change in the CPI-U is reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi-factor productivity index (MFP). The resulting AIF is then applied to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule. The formula used to calculate the change in the CPI-U is limited to positive increases. Therefore, even if the change in the CPI-U was negative over a 12-month period (a rarity in the post-war era), the change in the CPI-U cannot be negative. However, when the MFP reduction is applied, the statute does permit a...

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Time to Automate

Founded in 1964, now nationally recognized, Mohawk Ambulance Service is the largest privately owned ambulance service in upstate New York. Our organization services six emergency centers, makes 56,000 trips annually and employs a team of more than 250 staff members. Eighty percent of our trips are for emergency transports where patients are unknown, in critical condition or have no identifying information. Finding fast, efficient ways to verify demographics and discover insurance coverage for these patients is imperative for our revenue cycle and our bottom line. We’ve always worked closely with our local hospitals and nursing homes to obtain information. Many standard processes have been refined over the years with checks and balances to verify coverage, screen deductibles and reduce eligibility-related rejections before claims are submitted to a payor. But our billing team knew we could do more to eliminate duplicate data entry and processing lag time. This article describes our journey to a more streamlined billing process. It includes lessons learned and best-practice recommendations for other EMS providers looking to improve staff efficiency and reduce receivables. First Stop: Real-Time Insurance Discovery The first area we tackled was insurance discovery where we had three employees stationed. We focused on our self-pay...

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President Postma’s Capital Campaign

At the 2016 AAA Annual Conference & Trade Show, new president Mark Postma announced a visionary capital campaign to build our association’s reserves to $1 million. We invite all members to give as they are able to build a rainy day fund capable of weathering any storm. Thank you in advance for your support and participation. Funds contributed to the Capital Campaign can only be used by the association following a board vote. Pledge Now

CMS Medicare Ambulance Transports Booklet — Revised

CMS has released a revised Medicare Ambulance Transports Booklet. To order a hard copy, visit CMS’ Learning Management and Product Ordering System. Learn about: Ground and air ambulance providers and suppliers, vehicles, and personnel requirements Documentation requirements Coverage, billing, and payments Advance Beneficiary Notice of Noncoverage    

AAA 2016 State Balanced Billing & Direct Pay Survey Results Released

The AAA is providing its members with the results of two important surveys conducted of state laws impacting ambulance services.  The first chart entitled “2016 State Balance Billing Survey” shows whether a state restricts balancing billing of patients.  The second entitled “2016 State Direct Pay Survey” lists whether a state has a law requiring an insurer to send payment directly to a non-contracted ambulance service or a law allowing the insurer do send payment to the patient.  We thank AAA Medicare Consultant Brian Werfel for compiling the data and members of the AAA Medicare Regulatory Committee and the AAA membership to which Brian reached out for their assistance....

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A Preliminary Estimate of 2017 Medicare Rates

 On July 15, 2016, the Bureau of Labor Statistics released its monthly report on inflation.  This release includes the change in the Consumer Price Index for all urban consumers (CPI-U) for June 2016.  As a result, it is now possible to make a preliminary estimate of the Ambulance Inflation Factor (AIF) for calendar year 2017.  The AIF is main factor that determines the increase (or decrease) in Medicare’s payment for ambulance services. Calculating the 2017 AIF  The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year.  For 2017, this means the 12-month period ending on June 30, 2016.  Starting in calendar year 2011, the change in the CPI-U is reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi-factor productivity index (MFP).  The resulting AIF is then applied to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule. The formula used to calculate the change in the CPI-U is limited to positive increases.  Therefore, even if the change in the CPI-U was negative over...

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Making the Most out of Merchant Processing

American Ambulance Association members want to get the most out of their business relationships to drive the highest profit at the lowest cost. As is the case with any healthy business, it’s important to put in the time and effort required to research the best ways to be successful. Our recent webinar highlighted a few such factors and things to know about payment processing, as highlighted below: Pricing There are two different pricing structures that most payment processors use – tiered and interchange plus; and, the best-fit pricing structure is one that is designed to help your business thrive. Tiered Pricing Structure Tiered pricing is a rate structure in which several hundred different processing rates are packaged into tiers that represent three different possible rates. Most providers package the rates into three groups with varying markups. Unfortunately, there is no regulation behind how merchant account providers must package their tiers, which prevents merchants from knowing exactly how much a given provider is making on each transaction. Despite the prevalence of tiered pricing in the credit card processing industry, a more competitive and transparent pricing model is available in the form of Interchange-plus pricing. Interchange-Plus Pricing Interchange-Plus pricing is the most (more…)

AAA Launches Medicare Audit Activity Survey

In an effort to better determine a pattern of Medicare audit issues facing our members, the AAA has launched a survey to identify the different types of audit activity. The AAA will use the survey to inform federal policymakers about problems identified with the audits and how best to address the issues to reduce the burden of the audits on AAA members. It is therefore critical that you complete the survey to help us determine what audit issues your operation is facing. The survey is comprised of only 14 questions including contact, demographic and characteristic information about your organization and requests data about your claim denial and audit activity. The information will be kept confidential and privileged and will only be reported in the aggregate with no organization identifying information. Contact information will be used only to follow up should we have any questions. Should you have any questions regarding the survey, please contact AAA Senior Vice President of Government Affairs Tristan North at tnorth@ambulance.org. Thank you in advance for completing this important survey....

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