MedPAC Issues June 2016 Report to the Congress

MedPAC Issues June 2016 Report to the Congress with Chapter on Improving Efficiency and Preserving Access to Emergency Care in Rural Areas

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:

  • Cost-based payments do not direct payments toward isolated hospitals having the greatest financial difficulty, but rather reward hospitals in high-income areas with higher non-Medicare margins by providing them with higher Medicare payments.
  • Cost-based payments encourage providers to expand service lines with high Medicare and private-payer shares rather than primarily focus on services that are needed on an emergency basis.
  • Cost-based models reduce the incentive for hospitals to control their costs, which can lead to unnecessary growth in capital costs, despite declining volumes.

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:

  • Establishing a 24/7 emergency department model; and
  • Adopting a clinic with ambulance services model.

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.

 

Maximizing VA Reimbursements on Emergency Conditions

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

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

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

Credit Card Processing: Interchange Plus vs. Tiered Pricing

 

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 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 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.

Payline DataContact

Steve 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!

Choosing a Credit Card Processor for Your Ambulance Service

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:

  • Understand Credit Card Processing 101

    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)

  • Make sure your processor is advocating for you and your business

    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.

  • Find a processor with cutting-edge solutions

    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.