The American Ambulance Association (AAA) is pleased to announce the release of its new state-level whitepaper, Ground Ambulance Balance Billing: Overview and Recommendations. Developed by a collaborative team of industry experts, this comprehensive resource provides an in-depth examination of the complex regulatory landscape surrounding ground ambulance billing and the ongoing challenges of keeping consumers out of the middle of payment disputes. The whitepaper offers an overview of existing state laws, gaps in current policy, and pragmatic recommendations—including standardized payment methods and consumer protections—that can inform both policymakers and EMS providers nationwide.
By sharing promising practices from around the country and highlighting the recent work of the Ground Ambulance and Patient Billing Advisory Committee, Ground Ambulance Balance Billing: Overview and Recommendations underscores the AAA’s commitment to safeguarding patients while supporting fair, sustainable reimbursement for ambulance services. We encourage all EMS stakeholders, insurers, and legislators to review this important paper and join us in shaping policies that protect patients and ensure the ongoing availability of these vital, life-saving services.
I am saddened to begin the New Year with such grim and shocking news from Louisiana and New York. I am sickened and heartbroken—as I know you are—by the terror attack that struck New Orleans this weekend as well as the mass shooting in the Bronx. Our hearts ache for the victims and all those whose lives have been shattered by these senseless acts of violence. We also offer our deepest gratitude to our fellow first responders who selflessly rushed toward danger to provide skilled care and comfort in the midst of these tragedies. May their example galvanize us as we work in concert in support of EMS.
Despite these tragedies, as we ring in 2025, I am excited to begin my two-year term as the president of the AAA. I am deeply honored and humbled by the outpouring of support I have received as we begin this 24-month journey together.
I say TOGETHER because this is about US and OUR profession, and I don’t plan to do this alone. I need your participation as we move forward to ensure the best outcomes for all of us in emergency medical services.
Decades ago, when I began working in the business office (which was the kitchen) of what was then my parents’ small Arkansas ambulance service, I never imagined that one day our family of Pafford companies would care for communities in four states, nor that I would have the opportunity to serve my EMS colleagues on the American Ambulance Association board.
I’d like to thank the outgoing AAA President, my friend, Randy Strozyk, for his hard work and leadership. Randy’s dedication over the past two years has enhanced unity and camaraderie among our leaders, members, and fellow EMS stakeholder organizations. I applaud his efforts and those of the larger board, committee chairs, and vice chairs. I am privileged to continue working with this extraordinary group of mobile healthcare professionals.
Too often, EMS—especially private EMS—feels like an unappreciated and misunderstood underdog. 2025 presents an opportunity to change that narrative. One of my cardinal rules at Pafford EMS is, “no whining allowed,” and another is if you complain about a challenge, be prepared to bring forth a proposed solution at the same time. We each know the incredible value we bring to our communities and patients. Together, our voices will be heard in Washington as we share data and stories highlighting the impact of the 24/7 on-demand mobile healthcare we provide.
I hope to approach my AAA presidency with the same sense of urgency with which we treat our patients. As a profession, we can work side-by-side to quickly and effectively secure the extension of the Medicare add-ons beyond the current March 31 expiration date, then collaborate on advancing additional key priorities including sustainable reimbursement, innovative payment models, and solutions to EMS’s challenging workforce shortage.
To accomplish these shared goals, we ask that AAA members treat our advocacy efforts with the same care, grit, and tenacity we demonstrate in our communities every day. On behalf of the board, I ask that you please respond quickly to requests from our government affairs team to write letters or to set meetings with members of Congress. AAA’s grasstops relationships are sterling and have helped the association punch above its weight for decades. However, I believe all politics are local and you are the secret sauce in our success! Grassroots efforts rule the day in transitional times like these when every interest group is competing for dollars and attention. Nothing is guaranteed—we quite literally cannot advance ambulance advocacy without the active cooperation of every AAA member organization.
In addition to supporting you through lobbying, AAA proudly offers outstanding member educational opportunities. Learning and networking abound at the 2025 AAA Annual Conference & Trade Show. We can’t wait to see you—and a thousand of our mutual colleagues—in beautiful Lexington, Kentucky June 22–24. Speaker proposals are due January 31, and the full agenda will be announced in February. However, please don’t hesitate to register for the conference and book your hotel room today. From reimbursement to operations to human resources, AAA 2025 will offer informative, engaging executive-level content to help you keep service rolling. Additionally, thanks to the support of our exhibitors and sponsors, this year’s event will have fun extras including a welcome reception the night before the conference, trade show special events, and entertaining optional outings to visit Lexington’s famous racehorses and distilleries. You don’t want to miss it as we will roll out our southern hospitality and have a great time!
We also look forward to honoring the 2025 class of Stars of Life in Washington, DC November 3–5. Nominations will open in late summer for this year’s cohort of exemplary EMS professionals. We hope that your ambulance service will join AAA in celebrating your hometown heroes in our nation’s capital.
If you have not yet renewed your AAA membership for 2025, I encourage you to do so immediately—your dues power our ability to drive the policy that sustains EMS. As a friendly reminder, your membership includes complimentary access to dozens of webinars and e-books—log in to our website any time for on-demand education from Scott Moore, Brian Werfel, and countless volunteer leaders. Members also receive deep discounts on everything from medical supplies to uniforms to ambulances through Savvik Buying Group. Additionally, we are proud to support your team with counselor matching services and on-site critical incident stress management should the need arise. New for this year, the AAA mentorship match program will offer an exciting career development opportunity for staff of all levels. AAA delivers these resources and many others as part of a comprehensive member benefits package that we are confident pays for itself many times over. (If you need help updating your contact details or accessing your benefits, please contact hello@ambulance.org for assistance.)
Those of you I’ve had the pleasure of meeting in person know that state ambulance advocacy is a personal passion of mine. In the course of operating Pafford Medical Services, I have seen firsthand many times how strong state associations drive enhanced revenue for EMS as well as add might to state and federal lobbying efforts. If you are not yet connected to your state ambulance association, I encourage you to reach out today. For our part, AAA will continue to support state-level boards with resources, research, events, and connection opportunities through our State Association Forum network and State Association Leadership Excellence conference.
Last, but not least, I wanted to share with you that the board has initiated a strategic planning process for the association to ensure that AAA is positioned for continued success. Our trusted consultants at Davidoff Mission-Driven Strategy will be gathering candid feedback from members of all types and sizes. Your insights are essential to charting a course for 2025 and beyond. I thank you in advance for your participation in surveys and/or virtual focus groups that will take place in the coming months.
I look forward to collaborating with you to move EMS forward in the coming 24 months. Thank you again for your support and participation, and happy New Year!
On Saturday, December 21, the American Relief Act of 2025 (H.R. 10545) became law and thereby averted a partial federal government shutdown. Of critical importance to ground ambulance service organizations, H.R. 10545 also extends the temporary Medicare ambulance add-on payments of 2% urban, 3% rural and 22.6% super rural through March 31, 2025. In addition, the new law wipes clean the PAYGO scorecard preventing a potential 4% cut in Medicare reimbursement for ground ambulance and other Medicare services.
The House of Representatives passed by a vote of 366 to 34 the Continuing Resolution (H.R. 10545) to extend funding for the federal government just hours before reaching the previous funding deadline of midnight on December 20th. The Senate then passed H.R. 10545 by a vote of 85 to 11 late that evening. The CR funds the federal government primarily at current funding levels through March 14, 2025.
The negotiations on the American Relief Act were extremely tense with a more robust initial legislative package, which would have extended the Medicare ambulance add-ons for two years, being replaced with a slimmer bill with fewer and shorter health care provisions. The extension of ground ambulance service payments ended up being just one of twenty-five provisions in the final 118-page Continuing Resolution, which was originally over 1,600 pages.
The AAA greatly appreciates the advocacy of our champions and supporters on Capitol Hill to ensure that the temporary ambulance payments extension was included in the final CR. We also want to thank our AAA members for reaching out to their members of Congress to request their help with the add-on payments. We will continue to push for a longer extension of the ambulance payments at percentages higher than the current levels upon the expiration of the CR.
On November 21, 2024, the HHS Office of the Inspector General (OIG) issued Advisory Opinion 24-09. The opinion relates to a proposal by a municipal ambulance service to begin billing health insurances for treatment-in-place (TIP) services.
The Requestor historically did not charge patients or their insurance when it would respond to a 911 call and treat the patient at the scene. The Requestor indicated that it was considering the implementation of a charge for TIP services furnished in connection with a 911 response. This charge would be based on the level of care furnished to the patient at the scene, and would not exceed the amounts the Requestor currently charged for the same level of service furnished in connection with an ambulance transport. The Requestor indicated that it would impose this charge for all forms of third-party health insurance (i.e., it would bill both Federal health care programs and commercial insurers); however, the Requestor stated that it would not charge uninsured patients for TIP services. Under the proposed arrangement, the requestor would also agree to accept payment from a patient’s health insurance as payment-in-full, i.e., the Requestor would waive any cost-sharing amounts imposed by the patient’s health insurance.
For background purposes, there currently exists a safe harbor to the Federal anti-kickback statute (AKS) for cost-sharing waivers for emergency ambulance services[1]. To qualify for protection under the safe harbor, certain conditions must be met. These include requirements that: (1) the ambulance provider or supplier be owned and operated by a state, a political subdivision of a state, or a recognized tribal organization, (2) the ambulance provider or supplier provide “emergency responses,” (3) the ambulance provider or supplier offers the reduction or waiver on a uniform basis to all of its residents or tribal members, or to all individuals transported, and (4) that the ambulance provider or supplier not claim the waived amounts as bad debt for payment purposes under a Federal health care program. It is the requirement that the waiver be offered on a uniform basis to “all individuals transported” that created the potential need for the advisory opinion.
In other words, the Requestor was attempting to clarify whether the safe harbor was limited to ambulance transports, or whether the OIG would be willing to extend the protections of the safe harbor to all ambulance services, including TIP service.
As part of its analysis, the OIG first determined that the proposed arrangement would result in remuneration in the form: (1) cost-sharing waivers for TIP services covered by patients with commercial insurers and a handful of Medicare Advantage plans that currently cover TIP services and (2) services provided at no charge to patients that lack health insurance. The OIG further determined that this remuneration would implicate both the Federal anti-kickback statute (AKS) and the prohibition on beneficiary inducements. To reach this conclusion, the OIG noted that the cost-sharing waivers might induce Federal health care program beneficiaries to elect to receive other EMS services from the Requestor. The OIG then determined that the proposed arrangement would not qualify under any of the existing safe-harbors. Specifically, the OIG determined that the proposed arrangement would not fall under the existing safe harbor for emergency ambulance services because TIP services are not currently covered under the Medicare Program or the majority of State Medicaid Programs. The OIG further noted that, even if a State Medicaid Program did cover TIP services, the arrangement would still not qualify for the safe harbor because the safe harbor currently only covers ambulance transportation services.
While not qualifying for protection under an existing safe harbor, the OIG nonetheless determined that the proposed arrangement carried little risk of fraud or abuse. The OIG based this determination on several factors. First, the cost-sharing waiver would be applied to all patients receiving TIP services, regardless of their insurance. Second, because neither Medicare nor the majority of State Medicaid Programs currently cover TIP services, the arrangement would not result in any meaningful costs being incurred Federal health care programs. By contrast, the OIG noted that the arrangement might reduce Federal health care program expenditures, by avoiding the need for ambulance transportation and subsequent hospital care. Third, even in those states where Medicaid paid for TIP services, the arrangement was unlikely to increase utilization of EMS services. Finally, the OIG determined that the cost-sharing waivers were unlikely to “meaningfully affect” a patient’s decision to use the Requestor for further ambulance services, noting that patients’ future EMS usage is more likely to be impacted by other factors, including the patient’s location and the decisions made by a 911 dispatcher. For these reasons, the OIG issued a favorable advisory opinion.
The advisory opinion is notable because it is the first time the OIG has addressed the issue of cost-sharing waivers unrelated to an actual ambulance transport. As part of its opinion, the OIG acknowledged the potential benefits of TIP services, including their potential to decrease overall Federal health care program expenditures. The opinion also suggests that the OIG does not view TIP services as creating new compliance risks distinct from those raised by ambulance transportation in general. Thus, the opinion suggests that if the Medicare Program were to extend its ambulance benefit package to include TIP services at some point in the future, the OIG would likely be open to extending the current safe harbor to cover TIP services as well.
Contact:
Tristan North
tnorth@ambulance.org
October 10, 2024
Senator Debbie Stabenow Receives Inaugural EMS Legacy Award from the American Ambulance Association
Washington, D.C. — Senator Debbie Stabenow has been honored with the first-ever annual EMS Legacy Award by the American Ambulance Association (AAA) for her exemplary leadership and unwavering commitment to emergency medical services (EMS) during her distinguished tenure in the United States Senate.
The award recognizes Senator Stabenow’s significant contributions to the EMS community, particularly her role in introducing and championing critical legislation. Notably, she was instrumental in the creation of the Ground Ambulance Cost Data Collection System, which enhances transparency and supports the sustainability of ground ambulance services across the nation. Additionally, Senator Stabenow’s efforts led to the successful extension of Medicare Ambulance Add-On payments for five years, a vital support mechanism that helps ensure reliable emergency medical care for Medicare beneficiaries.
The EMS Legacy Award underscores the critical importance of legislative support for emergency medical services, highlighting Senator Stabenow’s role in elevating these issues on the national stage. Her advocacy ensures that EMS providers have the resources and support needed to deliver high-quality care.
About the American Ambulance Association:
The American Ambulance Association is a nonprofit organization that advocates for the interests of ambulance service providers and the patients they serve. With a mission to advance the profession and improve patient care, the AAA provides resources, education, and support to its members and the EMS community.
Contact:
Tristan North
tnorth@ambulance.org
October 10, 2024
Congressman Mike Bost Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Mike Bost (IL) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Congressman Bost introduced the bipartisan VA Emergency Transportation Access Act (S. 2757, H.R. 6433) to direct the Department of Veterans Affairs (VA) to further analyze the impact of the VA Final Rule on Special Modes of Transportation and create an advisory committee to evaluate future reimbursement rates for ambulance services.
The Rule as it stands would reimburse ambulance service providers below the costs of providing medical and transport services. S. 2757 would help ensure that ambulance service providers throughout Kansas and the country do not face further cuts to VA reimbursement which would limit their ability to provide lifesaving emergency medical services to our nation’s veterans.
Due to the efforts of Congressman Bost and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“We greatly appreciate the leadership of Congressman Moran in ensuring that our veterans and entire communities will continue to have access to vital ground ambulance service,” said AAA President, Randy Strozyk. “His perseverance paid off with the VA recognizing the need to delay implementation of the final rule to provide more time to address concerns that the new payment system could adversely affect ambulance access for veterans.”
The American Ambulance Association will be presenting Congressman Bost with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communities.
Contact:
Tristan North
tnorth@ambulance.org
October 10, 2024
Congressman Ryan Zinke Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Congressman Ryan Zinke (MT) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Congressman Zinke has led efforts to restrict the ability of the Department of Veterans Affairs to implement its Final Rule on Special Modes of Transportation which would reimburse ambulance service providers below the costs of providing medical and transport services to our veterans. Congressman Zinke has supported efforts to instead create an advisory committee to evaluate future VA reimbursement rates for ambulance services.
Due to the efforts of Congressman Zinke and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“We thank Congressman Zinke for his dedication and perseverance to ensuring that our veterans and entire communities will continue to have access to vital ground ambulance service,” said AAA President, Randy Strozyk.
The American Ambulance Association will be presenting Congressman Zinke with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communities.
Contact:
Tristan North
tnorth@ambulance.org
October 8, 2024
Senator Jerry Moran Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Jerry Moran (KS) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Senator Moran introduced with a bipartisan group of Senators the VA Emergency Transportation Access Act (S. 2757, H.R. 6433) to direct the Department of Veterans Affairs (VA) to further analyze the impact of the VA Final Rule on Special Modes of Transportation and create an advisory committee to evaluate future reimbursement rates for ambulance services.
The Rule as it stands would reimburse ambulance service providers below the costs of providing medical and transport services. S. 2757 would help ensure that ambulance service providers throughout Kansas and the country do not face further cuts to VA reimbursement which would limit their ability to provide lifesaving emergency medical services to our nation’s veterans.
Due to the efforts of Senator Moran and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“We greatly appreciate the leadership of Senator Moran in ensuring that our veterans and entire communities will continue to have access to vital ground ambulance service,” said AAA President, Randy Strozyk. “His perseverance paid off with the VA recognizing the need to delay implementation of the final rule to provide more time to address concerns that the new payment system could adversely affect ambulance access for veterans.”
The American Ambulance Association will be presenting Senator Moran with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communities.
Contact:
Tristan North
tnorth@ambulance.org
October 7, 2024
Senator Jon Tester Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Senator Jon Tester (MT) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Senator Tester introduced with a bipartisan group of Senators the VA Emergency Transportation Access Act (S. 2757, H.R. 6433) to direct the Department of Veterans Affairs (VA) to further analyze the impact of the VA Final Rule on Special Modes of Transportation and create an advisory committee to evaluate future reimbursement rates for ambulance services.
The Rule as it stands would reimburse ambulance service providers below the costs of providing medical and transport services. S. 2757 would help ensure that ambulance service providers throughout Montana and the country do not face further cuts to VA reimbursement which would limit their ability to provide lifesaving emergency medical services to our nation’s veterans.
Due to the efforts of Senator Tester and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“Senator Tester’s leadership on this issue has been instrumental in advancing our mission to preserve emergency medical services for veterans and entire communities,” said AAA President, Randy Strozyk. “His dedication to supporting our nation’s heroes exemplifies the kind of leadership we need to ensure that all veterans have access to timely and efficient emergency care.”
The American Ambulance Association will be presenting Senator Jon Tester with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communitie
Press Contact
Tristan North
Senior Vice President
American Ambulance Association
tnorth@ambulance.org
FOR IMMEDIATE RELEASE
Congresswoman Gluesenkamp Perez Awarded 2024 Legislator of the Year by the American Ambulance Association
Washington, D.C. — September 23, 2024 — Congresswoman Marie Gluesenkamp Perez has been recognized as the 2024 Legislator of the Year by the American Ambulance Association (AAA) for her outstanding leadership in addressing the critical workforce shortage facing the Emergency Medical Services (EMS) industry.
In a time when the EMS sector grapples with a significant shortage of qualified personnel, Congresswoman Gluesenkamp Perez has emerged as a vital advocate for meaningful change. Her introduction of the H.R. 6433, the PARA-EMT Act, has been a pivotal step in advancing solutions to recruit and retain EMS professionals across the nation.
“Congresswoman Gluesenkamp Perez’s commitment to the EMS workforce is not just commendable; it is essential,” said AAA President Randy Strozyk. “Her leadership has laid the groundwork for policies that will help alleviate the workforce crisis, ensuring that our communities receive the emergency care they deserve.”
The PARA-EMT Act aims to create an EMS Workforce Grant to help recruit, train, and retain EMS professionals and tasks the Department of Labor and Department of Health and Human Services with creating a study of the EMS workforce shortage and the training and education needed to meet the demands of the pre-hospital industry over the next decade. Additionally, the legislation includes a provision to assist combat medics with first response experience in transitioning into the civilian workforce.
Introduction of this legislation reflects the Congresswoman’s dedication not only to securing a strong future for emergency medical services to meet the needs of our communities, but also her dedication to serving our nation’s veterans.
The American Ambulance Association is honored to award our Legislator of the Year Award to Congresswoman Marie Gluesenkamp Perez, a true advocate of emergency medical services.
The award will be presented at the AAA Stars of Life event in Washington, D.C. on November 12th.
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About AAA
The American Ambulance Association represents ambulance services across the United States that participate in serving more than 75% of the U.S. population with emergency and non-emergency care and medical transportation. The AAA was formed in response to the need for improvements in medical transportation and emergency medical services. AAA views pre-hospital care not only as a public service, but also as an essential part of the total public health care system.
The Department of Veterans Affairs (VA) has notified Senate Committee on Veterans Affairs Chairman Jon Tester (D-MT) and Ranking Member Jerry Moran (R-KS) that the Department will be delaying implementation of the Final Rule on Special Modes of Transportation until February 16, 2029. The Committee has released a statement on the delay and the VA should be issuing a formal notification of the delay shortly in the Federal Register.
“I appreciate the VA providing the additional time to ensure a process for proper reimbursement of critical ambulance services for veterans and wholeheartedly thank Chairman Tester and Ranking Member Moran for their successful and tireless efforts in advocating for the delay,” stated AAA President Randy Strozyk. “Reimbursing ground ambulance services at Medicare rates would have a devasting impact on our members who are already struggling financially.”
The delay will allow time for a framework like the one outlined in the VA Emergency Transportation Access Act (S. 2757, H.R. 5530) to allow stakeholder input on future rates. “Our members appreciate the efforts of Senators Tester, Moran, Patty Murray, John Boozman and Susan Collins and Representatives Mike Bost and Ryan Zinke and the dozens of other members of Congress who helped push for the delay.”
The Final Rule on Special Modes of Transportation was originally scheduled to take effect on February 16, 2024, but in December 2023 the VA announced a one-year delay with the latest announcement delaying implementation for an additional four years. Under the final rule, the VA would reimburse for ambulance services provided through its beneficiary travel program at the lesser of the actual charges or Medicare rates.
We will provide more details about the delay when the VA issues its formal notice.
On September 6, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that CMS and its contractor, Wisconsin Physician Service Insurance Corporation (WPS), have begun the process of notifying nearly a million Medicare beneficiaries that were potentially impacted by a data breach involving WPS.
The data breach involved WPS’ use of the third-party application MOVEit. MOVEit is a file transfer application developed by Progress Software. In May 2023, a hacker group called CL0P discovered a security vulnerability that allowed the company to steal sensitive information from secure databases used by numerous governmental agencies and corporations. This included the protected health information (PHI) of Medicare beneficiaries and non-Medicare beneficiaries stored within WPS’ databases.
The notices inform affected Medicare beneficiaries of the steps they can take to protect themselves. As part of its remedial efforts, WPS is offering affected Medicare beneficiaries one year of free credit monitoring from Experian.
CMS indicated that it was not aware of any reported incidents of fraud or improper use of a Medicare Beneficiary Identifier (MBI). However, CMS noted that, if the beneficiary’s MBI was potentially impacted, they would mail a new Medicare card with a new MBI to the patient. Thus, the data breach has the potential to impact the patient demographic information you currently maintain within your billing systems. This is especially true for AAA Members that operate in Medicare jurisdictions currently administered by WPS (Iowa, Indiana, Kansas, Michigan, Missouri, and Nebraska).Specifically, the MBIs on file for existing patients may no longer be accurate. This also has the potential to impact Medicare eligibility information that you receive from other parties like hospitals, skilled nursing facilities, etc.
AAA Members will have to make a business judgment on how to address these potential concerns. One possible option would be to implement a process to confirm the MBI of existing patients prior to the submission of new claims. Another possible option might be to implement internal procedures to flag claims that are denied for an incorrect MBI as potentially related to this issue, and to then verify the patient’s correct MBI prior to resubmitting any denied claims.
A Message from GAPBAC Committee Member Shawn Baird
Please see below for a video message from former American Ambulance Association President Shawn Baird, who participated on the Ground Ambulance Patient and Billing Advisory Committee. A formal analysis of the complete report to Congress is forthcoming.
Video Transcript
Hello, I’m Shawn Baird, past president of the American Ambulance Association.
Together with my fellow ambulance profession representatives Ted Van Horne, Regina Crawford, and Rhonda Holden, I was privileged to speak on behalf of AAA members and the EMS profession as a whole during the deliberations of the Ground Ambulance and Patient Billing Advisory Committee, also known as GAPBAC.
Today, I’m excited to share with you the culmination of our efforts—the release of a report to Congress that could transform how ground ambulance services are reimbursed, ensuring better protection for patients against surprise medical bills as well as fair compensation for the essential mobile healthcare we deliver daily.
We know that the patient care and transport we provide every day, 24/7, is vital to the health and welfare of our communities. In many parts of the country, we are the only healthcare available within hours. I am excited that if Congress acts on these recommendations, patients can not only continue to depend on our vital care, but also be relieved of the financial stress of the unknown bill when insurance falls short of appropriate payment. Quite frankly, if adopted by Congress, these recommendations would take patients out of the middle between providers and insurers, and free us to remain focused on what we do best; taking care of patients, 24/7.
Let me rewind a bit and give you the full context for this report.
GAPBAC was formed following the American Ambulance Association’s successful advocacy efforts to carve ground ambulance services out of the No Surprises Act. Through the dedication of AAA volunteer leaders made possible by your dues investment, we were able to successfully educate legislators about the unique nature of EMS. We effectively highlighted our inability to pick and choose patients, our role as the safety net provider in rural and medically underserved urban areas, as well as our sky-high costs of readiness. Instead of rolling ambulance services into a one-size-fits-all healthcare billing scheme that wouldn’t work for EMS, legislators had the vision and foresight to create the GAPBAC committee.
The group’s charter was signed in November 2021, and the roster was announced in December 2022. We are proud that former American Ambulance Association board member Asbel Montes was selected to take the helm as Chair.
Since then, our committee, composed of patient advocates, physicians, EMS experts, government officials, and insurance industry representatives, has worked collaboratively to address a critical issue—out-of-network billing for ground ambulance patients covered by non-ERISA health plans.
This discussion presented an extraordinary challenge as ambulance services face skyrocketing costs, flat reimbursement from Medicare, and an unprecedented workforce shortage. At the same time, our patients were sometimes confused by the complex health insurance landscape including copays, deductibles, and policy limitations.
But the GAPBAC panel, with the help of experts including AAA’s own Kathy Lester, persevered. Through research, dialogue, and compromise, GAPBAC’s team members developed 14 key recommendations that, if adopted by Congress, would protect patients, financially sustain EMS, enhance transparency, and empower state and local governments to determine fair reimbursement rates for their residents.
While I urge you to read the report to Congress in its entirety, rest assured that the AAA advocacy team will soon share a concise summary with our membership.
As I mentioned, the release of this report has been no small task. The collaboration across various stakeholder groups was unprecedented in EMS history, and every voice brought valuable insights, driving us toward solutions that consider all perspectives on the complex mobile healthcare reimbursement landscape. Together, we’ve laid down a framework that I believe will lead to significant improvements, ensuring that millions more Americans are fully covered during some of the most critical moments of their lives.
As we present our final findings, I hope that the recommendations will be met with thoughtful consideration by Congress and regulators—the well-being of our patients and the integrity of our out-of-hospital healthcare system depend on it. Thank you to American Ambulance Association President Strozyk, the AAA board and committee chairs, and you, the AAA membership, for the overwhelming support through this journey. Together, we will continue to advocate for a sustainable future for EMS!
Shawn Baird
Immediate Past President
American Ambulance Association
