AAA Operations & Human Resources Consultant Scott Moore, Esq has developed a summary of financial relief provisions from the recent CARES Act. The resource will help your organization evaluate in which programs it may qualify to participate.
The Centers for Medicare and Medicaid Services (CMS) held its latest Open Door Forum on Wednesday, March 28, 2019. As with past Open Door Forums, CMS started the call with the following announcements:
Following the announcements, CMS moved into a Question & Answer period. The majority of the questions related to the ET3 pilot program. As is typical, many questions were not answered on the call; instead, CMS asked the individual to submit their question in writing. However, the following questions were answered on the call:
Questions? Email Brian at bwerfel@aol.com
The Volunteer Medical Service Corps of Narberth was established in 1944 by residents of Narberth Borough, a suburb of Philadelphia, to provide transportation and first aid for soldiers returning from World War II via Philadelphia’s ports. The organization, now known as Narberth Ambulance, has expanded over the past 70 years from a small station with two ambulances to a full-fledged EMS service that makes nearly 10,000 trips annually, employs 33 full-time staff, 44 part time employees, and 80 volunteers. Narberth covers four Philadelphia area communities with two stations, seven ambulances, two responder vehicles and one mass casualty/rehab bus.
While Narberth Ambulance has seen tremendous growth and success throughout its history, recent times have brought new challenges. Changing technology in the healthcare industry paired with declining reimbursement over the past several years left Narberth, like many other EMS services, facing issues with its billing system and claims processing. These complications made claims longer to work and payment harder to collect. At the height of this problem, Narberth’s billing team needed from five to ten business days to process a claim.
The Issue at Hand
According to Meg Nelson, billing lead for Narberth, “The first barrier encountered by our billing staff was simply trying to obtain correct demographic and insurance information for our patients.” Narberth faced ongoing issues in efforts to receive face sheets and up-to-date information from local hospitals. Despite access to EHRs at hospitals, repeated follow-up calls became a necessity, hampering the productivity of those involved on both the hospital and EMS sides.
John Roussis, executive director of Narberth Ambulance, also shared his insight on the issues. “Because our data was often incorrect, we experienced a high volume of return mail,” he said. “The administrative burden was a huge challenge with hundreds of steps to hunt down correct addresses, multiple piles of return mail, and extra postage to resend invoices.” Furthermore, decreases in coverage from commercial and government payors made it increasingly difficult to obtain correct, valid and billable insurance information to process claims and collect payment. Narberth clearly needed to make monumental changes to its claims processing, insurance discovery and payor reimbursement practices to avoid further harm to the organization’s financial stability.
EMS Billing Interoperability Cuts Manual Intervention by 80%
In 2017, Narberth implemented new revenue cycle technology to increase efficiency in each of the previously mentioned areas. The application was seamlessly integrated with ESO, Narberth’s established billing system, to reduce return mail, boost staff productivity and hasten reimbursement. Here’s how interoperability between the two systems works:
With this system in place, Narberth’s billing staff conduct their manual process only if no information is available—a mere 20 percent of the time. Narberth Ambulance has effectively dropped its time to work a claim from an estimated seven days down to only seven minutes.
“We’ve relieved billing burdens and effectively reduced time to process claims by 66 percent,” said Roussis. “We are now performing only one third of the paperwork, calls and claims-related tasks that we handled before. Our team calls the integrated ESO and Payor Logic solution the magic button for EMS billing.”
Payability and Deductibles Next Target
With its billing system now automated and integrated, Narberth’s claims processing efficiency is better than ever—time waste is down and dollars have become far easier to collect. However, Roussis doesn’t want to stop there.
Roussis intends to continue tackling inefficiency. He plans to use Payor Logic to help address communication issues with commercial payors, analyze payment likelihood for self-pay accounts, and improve the organization’s deductible management.
The issues Narberth Ambulance faced are bound to become more common in the EMS world as the healthcare industry becomes more reliant on increasingly complex technology. The most important takeaway in the face of change is that integrated EMS technology solutions are out there to keep billing struggles from distracting providers from their top priority—saving lives.
The 199A passthrough business deduction was created under the Tax Cuts and Jobs Act that was signed into law on December 22, 2017. The creation of the 199A section within this legislation has since created many questions and needed clarifications.
On August 8, 2018, the Internal Revenue Service (IRS) issued proposed regulations that provide guidance that further clarifies which passthrough businesses are able to take advantage of this deduction as well as how taxpayers and tax professionals alike can navigate this new deduction. Section 199A allows domestic businesses operated as a sole proprietorship or through a partnership, Limited Liability Company (LLC), S corporation, trust, or estate to deduct up to 20% of qualified business income from tax years between 2018 and 2025.
Those who have taxable income of $315,000 or less for joint filers and $157,500 or less for single filers will now be able to take advantage of the deduction. Those who exceed these taxable incomes will be subject to certain limitations. These limitations could include the taxpayer’s taxable income and limitation by 50% of W-2 wages. These regulations clarify that individuals and certain trusts and estates may be able to take a deduction of up to 20 percent of their combined qualified real estate investment trust (REIT) dividends and qualified publicly traded partnership (PTP) income, including qualified REIT dividends and qualified PTP income earned through passthrough entities.
The 199A deduction can be used at the partner or shareholder level and takes into account the shareholder’s allocable share of items of qualified income and loss, unadjusted basis of the partnership or S-corporation, and W-2 wages. This proposed regulation reinforces that income earned through a C-corporation is not entitled to the deduction. Those who are in favor of this deduction maintain that it will help to reduce the tax rate on pass through and small businesses in order to provide increased parity between pass throughs and C-corporations.
The IRS released guidance with the proposed regulation that includes methods to calculate W-2 wages for purposes of section 199A. Additionally, the IRS published a FAQ page that can also be used as a resource in navigating this new deduction and can be found here.
There is a 45-day comment period where comments can be submitted to the IRS. This comment period is a great opportunity for AAA members who could benefit from the deduction to weigh in, especially where the proposed rule specifically seeks comment in the area of whether a pass-through entity should be able to aggregate its trades or businesses and whether there are proper times to include Section 707(a) payment in qualified business income. A hearing was scheduled by the Department of Treasury on the 199A regulations that will be held on October 16, 2018.
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.
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 negative AIF for any calendar year. That is precisely what occurred in 2016, where the change in the CPI-U was 0.1% and the MFP was 0.5%. As a result, the industry saw an overall reduction in its Medicare rates of 0.4%.
Based on current data, it is highly unlikely that the AIF will be negative in 2018. For the 12-month period ending in June 30, 2017, the Bureau of Labor Statistics (BLS) currently calculates the change in the CPI-U to be approximately 1.6%.
CMS has yet to release its estimate for the MFP in calendar year 2018. However, assuming CMS’ projections for the MFP are similar to last year’s projections, the 2018 MFP is likely to be in the 0.3% to 0.5% range.
Therefore, at this time, my best guess is that the 2018 Ambulance Inflation Factor will be a positive 1.1% to 1.3%.
Please note that this estimate assumes the Bureau of Labor Statistics does not subsequently revise its inflation estimates. Please note further that this projection is based on the MFP being similar to last year. To the extent either of these numbers changes in the coming months (up or down), my estimate of the 2018 AIF would need to be adjusted accordingly. Ultimately, the 2018 AIF will be finalized by CMS by Transmittal, which typically occurs in the early part of the 4th quarter.
Assuming all other factors remained the same, calculating your 2018 Medicare rates would be a relatively simple exercise, i.e., you would simply add 1.1 to 1.3% to your 2017 rates. However, as part of its 2018 Physician Fee Schedule Proposed Rule (issued July 21, 2017), CMS proposed minor changes to the GPCIs. These changes can be viewed by going to the Physician Fee Schedule page on the CMS website, and clicking the link for the “CY 2018 PFS Proposed Rule Addenda” (located in the Downloads section). You would then need to open the file for “Addendum E_Geographic Practice Cost Indicies (GPCIs).”
If the PE GPCI in your area is proposed to increase, you can expect your 2018 Medicare rates to increase by slightly more than 1.1 – 1.3%. If the PE GPCI in your area is proposed to decrease, you can expect your 2018 Medicare rates to increase by slightly less than 1.1 to 1.3%.
If you are looking for a more precise calculation of your rates, you will need to use the following formulas:
Medicare Allowable = (UBR x .7 x GPCI) + (UBR x .3)
Medicare Allowable = (UBR x .5 x GPCI) + (UBR x .5)
In this formula, the “UBR” stands for the unadjusted base rate for each HCPCS code. These are calculated by multiplying the national conversation factor by the relative value unit assigned to each base rate. To save some time, estimates for the 2018 unadjusted base rates are reproduced below (using the low-end estimate for the AIF):
| Base Rate (HCPCS Code) | 2018 Unadjusted Base Rate |
| BLS non-Emergency (A0428) | $224.74 |
| BLS emergency (A0429) | $359.58 |
| ALS non-emergency (A0426) | $269.68 |
| ALS emergency (A0427) | $427.00 |
| ALS-2 (A0433) | $618.02 |
| Specialty Care Transport (A0434) | $730.39 |
| Paramedic Intercept (A0432) | $393.29 |
| Fixed Wing (A0430) | $3,049.69 |
| Rotary Wing (A0431) | $3,545.72 |
Plugging these UBRs into the above formulas will result in adjusted base rates for each level of ground and air ambulance service. The final step is to apply whatever temporary adjustments are in effect under the Medicare Ambulance Fee Schedule. For example, in 2017, there were adjustments in place for urban (2%), rural (3%) and super-rural (22.6% over the corresponding rural rate) transports. Note: these temporary adjustments are currently set to expire on December 31, 2017. Therefore, absent further legislation, they should not be added to the adjusted base rates for 2018.
At this time, I am estimating the following rates for Medicare mileage:
| Base Rate (HCPCS Code) | 2018 Unadjusted Base Rate |
| Ground Mileage – Urban | $7.23 |
| Ground Mileage – Rural Miles 1 – 17 | $10.84 |
| Ground Mileage – Rural Miles 18+ | $7.23 |
| Fixed Wing Mileage – Urban | $86.5 |
| Fixed Wing Mileage – Rural | $12.98 |
| Rotary Wing Mileage – Urban | $23.09 |
| Rotary Wing Mileage – Rural | $34.64 |
Please keep in mind that a number of assumptions went into these projections. The Bureau of Labor Statistics can revise its inflation figures in the coming months. CMS may announce an MFP projection that differs from what we expect. CMS may also announce that it is electing not to finalize its proposed changes to the GPCI (highly unlikely). If any of these assumptions was to change, these projections would need to be revised. Therefore, I would suggest that you view these as rough estimates at best. The AAA will update members as more information becomes available in the coming months.
Have an issue you would like to see discussed in a future Talking Medicare blog? Please write to me at bwerfel@aol.com.
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.
The first area we tackled was insurance discovery where we had three employees stationed. We focused on our self-pay patients and transports lacking complete demographic or insurance information. The goal was to eliminate manual steps and workflow lags—which we quickly achieved.
The original process involved building a list, submitting it to Payor Logic, waiting three days for feedback, and then re-entering information into our billing system. By bringing our vendors together to meet with our team, a real-time technology solution was developed and implemented.
Now our insurance verification team has immediate access to Payor Logic’s search capabilities. Insurance discovery is an online, real-time process. Lists, batches, searching websites and waiting for results have all been eliminated. Also, the two vendors built a crosswalk that integrates insurance coverage results back into our billing system to eliminate duplicate data entry and rekeying.
The productivity our verification team is now able to achieve is amazing. They now do the work of three staff with only two employees—a 30 percent boost in staff efficiency for insurance verification.
At Mohawk, we use a combination of technology solutions to support our revenue cycle. But each company worked independently—creating separate silos. Billers would have to search across several different systems, payor websites and the digital pages to collate all the various demographic and insurance data required to submit a claim. We had technology, but the process remained cumbersome and labor intensive.
By working with our vendors, we built points of integration to increase the number of claims processed without adding billing staff. For example, once a biller pulls up a trip, dozens of data elements from the billing system are uploaded into a single view to eliminate searching and save time.
Everything the biller needs to complete a claim is displayed in a consolidated view, consistent across all Mohawk companies. Billers can easily see patient signature, facility signature, narrative, vital signs, advanced life support and more. This level of integration eliminates the need to look at every page of the system to build the claim—saving dozens of hours every week.
Like most EMS providers, our mission is to uphold the highest standard of services with consistent devotion to delivering superior emergency medical care. And through this automation project, we took service excellence one step further—delivering world-class service throughout our billing process. We find more insurance coverage, reduce eligibility-related rejections, convert self-pay accounts and collect more revenue from the right source. Results thus far include:
EMS providers looking to streamline the billing process should revisit their existing technology applications and engage in serious discussions with current vendors. New capabilities are out there and should be explored. The automation efforts described above have resulted in an efficiency uptick for Mohawk, despite being short staffed. New workflows for verification are being maintained by our team and next steps for automation expansion are being discussed. By keeping open communications and an ongoing dialogue with all parties involved, this automation experience has been a win-win for our business, our staff and our patients.
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.
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 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 negative AIF for any calendar year. That is precisely what occurred in 2016, where the change in the CPI-U was 0.1% and the MFP was 0.5%. As a result, the industry saw an overall reduction in its Medicare rates of 0.4%.
Fortunately, it seems unlikely that we will see a negative AIF in 2017. For the 12-month period ending in June 2016, the Bureau of Labor Statistics (BLS) currently calculates the change in the CPI-U to be exactly 1.00%.
CMS has yet to release its estimate for the MFP in calendar year 2017. However, assuming CMS’ projections for the MFP are similar to last year’s projections, the 2017 MFP is likely to be in the 0.5% range.
Therefore, at this time, my best guess is that the 2017 Ambulance Inflation Factor will be a positive 0.5%.
Please note that this estimate assumes the Bureau of Labor Statistics does not subsequently revise its inflation estimates. Please note further that this projection is based on the MFP being similar to last year. To the extent either of these numbers changes in the coming months (up or down), my estimate of the 2017 AIF would need to be adjusted accordingly. Ultimately, the 2017 AIF will be finalized by CMS by Transmittal, which typically occurs in the early part of the 4th quarter.
Impact on the Medicare Ambulance Fee Schedule
Assuming all other factors remained the same, calculating your 2017 Medicare rates would be a relatively simple exercise, i.e., you would simply add 0.5% to your 2016 rates. However, as part of its 2017 Physician Fee Schedule Proposed Rule (issued on July 15, 2016), CMS proposed extensive changes to the GPCIs. These changes can be viewed by going to the Physician Fee Schedule page on the CMS website and clicking the link for the “CY 2017 PFS Proposed Rule GPCI Public Use Files” (located in the Downloads section). You would then need to open the file for “CY 2017 Proposed Addendum E.”
If the PE GPCI in your area is proposed to increase, you can expect your 2017 Medicare rates to increase by slightly more than 0.5%. If the PE GPCI in your area is proposed to decrease, you can expect your 2017 Medicare rates to increase by slightly less than 0.5%.
If you are looking for a more precise calculation of your rates, you will need to use the following formulas:
Ground Ambulance Services
Medicare Allowable = (UBR x .7 x GPCI) + (UBR x .3)
Air Ambulance Services
Medicare Allowable = (UBR x .5 x GPCI) + (UBR x .5)
In this formula, the “UBR” stands for the unadjusted base rate for each HCPCS code. These are calculated by multiplying the national conversation factor by the relative value unit assigned to each base rate. To save some time, estimates for the 2017 unadjusted base rates are reproduced below:
|
Base Rate (HCPCS Code) |
2017 Unadjusted Base Rate |
| BLS non-Emergency (A0428) | $221.84 |
| BLS emergency (A0429) | $354.95 |
| ALS non-emergency (A0426) | $266.21 |
| ALS emergency (A0427) | $421.51 |
| ALS-2 (A0433) | $610.08 |
| Specialty Care Transport (A0434) | $721.00 |
| Paramedic Intercept (A0432) | $388.23 |
| Fixed Wing (A0430) | $3,010.52 |
| Rotary Wing (A0431) | $3,500.17 |
Plugging these UBRs into the above formulas will result in adjusted base rates for each level of ground and air ambulance service. The final step would be to apply the current adjustments for urban (2%), rural (3%) and super-rural (22.6% over the corresponding rural rate).
2017 Projected Rates for Mileage:
At this time, I am estimating the following rates for Medicare mileage:
| Base Rate (HCPCS Code) | 2017 Unadjusted Base Rate |
| Ground Mileage – Urban | $7.28 |
| Ground Mileage – Rural Miles 1 – 17 | $11.02 |
| Ground Mileage – Rural Miles 18+ | $7.35 |
| Fixed Wing Mileage – Urban | $8.54 |
| Fixed Wing Mileage – Rural | $12.81 |
| Rotary Wing Mileage – Urban | $22.79 |
| Rotary Wing Mileage – Rural
|
$34.19 |
Please keep in mind that a number of assumptions went into these projections. The Bureau of Labor Statistics can revise its inflation figures in the coming months. CMS may announce an MFP projection that differs from what we expect. CMS may also announce that it is electing not to finalize its proposed changes to the GPCI (highly unlikely). If any of these assumptions was to change, these projections would need to be revised. Therefore, I would suggest that you view these as rough estimates at best. The AAA will update members as more information becomes available in the coming months.
Have an issue you would like to see discussed in a future Talking Medicare blog? Please write to me at bwerfel@aol.com.
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:
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 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 is the most transparent pricing model and it’s what Payline offers to all AAA members. This model for pricing puts the power in your hands by giving you a straightforward and clear explanation of charges. Interchange describes the rates that come directly from the card networks. No merchant or processing company has any control over these rates. Every merchant pays interchange, which varies based on the type of card your customer is using. The plus is what Payline is charging you for our service. It is our profit and is shown in terms of a small percentage markup and a minimal transaction cost.
Chargebacks cost card-not-present (CNP) merchants millions of dollars each year. CNP merchants need to take extra measures to prevent chargebacks and aggressively work to recover funds lost to chargebacks. Chargebacks occur when a cardholder disputes a merchant charge and a debit is made to the retailer’s account. The issuing bank charges merchants a fee for every chargeback received. Merchants with a high ratio of chargebacks may also receive additional fines or run the risk of losing their payment processing privileges altogether. While the chargebacks mechanism was created to protect consumers against fraudulent behavior, some consumers have found that it is easy to dispute legitimate charges – this form of friendly fraud creates a significant financial burden for merchants.
One easy way to know if you are getting the most out of your merchant processing is to complete a statement review with a trusted processing representative. “Most of the issues I look for in statement reviews with AAA members is size of ticket and what kind of pricing structure they are currently billed,” said Paddy Houlihan, Payline Data representative. “It’s important for members of the American Ambulance Association to know that if they still have a terminal and process that way that the cost to key a card can go up to as high as 0.30% versus swiping a card in person. If the business is doing large transactions it is usually in their best interest to go the payment gateway route and provide a “pay now” button on their website.”
Some partnerships make understanding new technologies difficult for you; others, like Payline Data, provide you with everything you need to know upfront. To learn more about credit card processing solutions that can help your business grow, contact Paddy Houlihan at Payline.
Contact us today via email or by phone (800) 284-7401 and we would be glad to run a statement analysis to show you how you can save money and cut costs on processing fees for the betterment and growth of your business.
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.
Medicare Payment Advisory Commission (MedPAC or the Commission) has issued its June 2016 Report to the Congress. The June report includes recommended refinements to Medicare payment systems and identifies issues affecting the Medicare program, broader changes in health care delivery, and the market for health care services.
Chapter 7 focuses on preserving access to emergency care in rural areas. The Commission recognizes that access to inpatient and emergency services in rural areas is threatened because of the dwindling populations. Declining populations can lead to fewer hospital admissions and reduced efficiencies that can create financial and staff problems for hospitals. The Report notes that “[d]eclining volume is a concern because low-volume rural hospitals tend to have worse mortality metrics and worse performance on some process measures.” In addition, “low-volume CAHs have the difficult job of competing with each other for a shrinking pool of clinicians who want the lifestyle of operating an outpatient practice during the day, covering inpatient issues that arise at night, and covering the emergency department.”
Under current policies, most rural hospitals are critical access hospitals (CAHs). They receive a cost-based payment for providing inpatient and outpatient services to Medicare beneficiaries. To receive these payments, a hospital must maintain acute inpatient services. In rural areas, many small towns do not have a sufficient population to support such a model. Yet eliminating these services would mean giving up the supplemental payments that their hospitals receive through the CAH cost-based payment model.
The hospital prospective payment system serves as the payment model for other hospitals. Rural providers receive supplemental payments, which are also linked to providing inpatient services.
MedPAC highlights the concerns with cost-based payment models:
In light of these challenges, MedPAC sets forth a two of options that would give isolated rural hospitals the option of converting to an outpatient-only model while maintaining their special payment arrangements. These models seek to ensure access to essential services:
Under the 24/7 emergency department model, the hospital would be paid under the outpatient prospective payment rates and would receive an annual grant/fixed payment from Medicare to cover the standby costs associated with 24/7 emergency services. The current supplemental payments would be redirected to support this annual grant/fixed payment amount. If a hospital chose to use inpatient beds as skilled nursing facility (SNF) beds, it would be reimbursed under the Medicare SNF prospective payment system. The hospital could be required to use the fixed payment for emergency standby capacity, ambulance service losses, telehealth capacity, and uncompensated care in the emergency department.
Under the clinic and ambulance model, hospitals could convert their existing inpatient facilities into primary care clinics. These clinics would be “affiliated” with an ambulance service. Medicare would pay the prospective rates for primary care visits and ambulance transports. Medicare would provide an annual grant/fixed payment to support the capital costs of having a primary care practice, the standby costs of the ambulance service, and uncompensated care costs.
The Commission recognizes that the “low population density would also make it difficult to retain primary care providers and support an ambulance service.” It could also be difficult to describe the exact level of primary care and ambulance access that is required to receive the fixed Medicare payment.
MedPAC reiterates its position that “supplemental payments beyond the standard PPS rates should be targeted to isolated rural providers that are essential for access to care.” Thus, it states that a program to support stand-alone emergency departments should be limited to facilities that are a minimum distance in road miles from the nearest hospital.
When it comes down to the pricing structures offered by different credit card payment processors, how do you determine which is best for your ambulance service? The American Ambulance Association has teamed up with Payline Data to kick confusion to the curb.
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 is the most transparent pricing model and it’s what Payline offers to all AAA members. This model for pricing puts the power in your hands by giving you a straightforward and clear explanation of charges. Interchange describes the rates that come directly from the card networks. No merchant or processing company has any control over these rates. Every merchant pays interchange, which varies based on the type of card your customer is using. The plus is what Payline is charging you for our service. It is our profit and is shown in terms of a small percentage markup and a minimal transaction cost.
The best-fit pricing structure is one that is designed to help your business thrive. To hear more about our exclusive pricing option for AAA members, call our friendly Payline representative for a free, no-obligation quote today.
ContactSteve Marshall
Director of Corporate Partnerships
smarshall@paylinedata.com
(800) 284-7401
Your membership is important to us–let us know what you think of your Payline experience!
In the fast-paced life of an American Ambulance Association member, taking the time to evaluate credit card processing needs for can feel like a daunting task. The idea alone is enough to make some emergency vehicle businesses stick with the same old merchant processor when, unbeknownst to them, they are likely losing out on value added services and low rates that could help their business grow. Here are a few tips for choosing a credit card processor for your organization that will enhance your business operations:
Credit card processing can seem like a complicated industry, and while it’s true that payments aren’t always black and white, a quality payment processor will help you understand the gray area. Credit card processing is essentially the backend work that occurs every time your business runs a credit or debit card transaction. The first part of the transaction is known as authorization (getting approval from the bank for the transaction) and the second part is settlement (processing of the actual sale, in which funds are transferred from the issuing bank to the merchant account). What it boils down to is this: payment processing is the expansion of your commerce reach as a business, and having one is necessary to optimize your business’s growth. (MORE: Read AAA’s EMS Card Payment Processing Guide)
It’s no secret that finding a best-fit business solution for your business takes time and careful consideration. It’s likely that there are many players are involved in helping you make business decisions, so it’s important to have a merchant advocate when selecting a payment processor. A quality payment processor for your business will provide you with an analysis of your recent processing statements and pinpoint where you might be able to cut costs. Money saved on processing can in turn be invested into growing your business and expanding your client reach.
Any business that accesses debit and credit cards for payment is equally affected by the threat of fraud. A credit card processor that is truly beneficial to your business will seek out the right value added services that can assist you in the fight against fraud. With the new EMV chip cards that are being circulated, it’s important to consider the need for a terminal that can accept all types of cards. Other services offered by the best processors include ACH processing, USB readers, mobile readers, and cloud-based solutions. As commerce rapidly adapts to today’s merchant and consumer needs, your business needs a processor that will offer these solutions and more.
Sticking with a processor that isn’t providing you with the support your business needs isn’t worth your time. To learn more about credit card processing solutions that can help your business grow, contact Steve Marshall at Payline.
Contact us today via email or by phone (800) 284-7401 and we would be glad to run a statement analysis to show you how you can save money and cut costs on processing fees for the betterment and growth of your business.