CMS Open Door Forum & Follow Up AAA Member Q&A Call – Thursday, June 14

The Centers for Medicare and Medicaid Services has scheduled its next Ambulance Open Door Forum for Thursday, June 14 at 2:00 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call. CMS Ambulance Open Door Forum June 14 | 2:00 PM ET Participant Dial-In Number:  1-800-837-1935 Conference ID #: 33271311 Questions? Have more questions? The AAA is here to help! Following the Open Door Forum, the AAA will host a Q&A conference call open to all members. AAA Follow Up Q&A June 14 | 3:00 PM ET 1-800-250-2600 Pin: 73556603# Speakers: AAA Senior Vice President of Government Affairs, Tristan North; AAA Medicare Consultant, Brian Werfel, Esq.; AAA Healthcare Lobbyist, Kathy Lester, Esq.; AAA Medicare Regulatory Committee Chair, Rebecca Williamson; and AAA Medicare Regulatory Committee Vice-Chair, Angie McLain

Talking Medicare: A Good Thing Poorly Explained

On April 13, 2018, CMS released two Transmittals, Transmittal 243 and Transmittal 4021, and a related MedLearns Matter Article (MM10550). Collectively, these documents clarify Medicare’s coverage of ambulance transportation of SNF residents in a stay not covered by Part B, but who have Part B benefits, to the nearest supplier of medically necessary services that are not available at the SNF. This clarification relates to both the ambulance transport to the site of medical care, and the return trip. In order to properly understand the clarification, it is helpful to review Medicare’s coverage of ambulance transportation provided to SNF residents. At the onset, it is important to note that Medicare draws a distinction between the first 100 days of a beneficiary’s SNF stay, and any subsequent days of the same stay. The first 100 days are commonly referred to as the “Part A Period.” Under current Medicare rules, all ambulance transportation provided during the Part A Period is the financial responsibility of the SNF, unless a specific exemption applies. Outside the Part A Period, Medicare’s coverage rules generally mirror the rules applicable to ambulance transports that originate at the patient’s residence. However, there is an exception that relates to transportation...

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Update on Medicare Reimbursement Issues

The AAA would like to take this opportunity to update members on a number of issues related to Medicare reimbursement: CMS and its contractors have begun adjusting claims for ground ambulance services to reflect the restoration of the temporary add-ons. Section 50203(a) of the Bipartisan Budget Act of 2018 retroactively reinstated the temporary add-ons for ground ambulance services. These add-ons increase the applicable Medicare allowables by 2% in urban areas, 3% in rural areas, and 22.6% in “super rural” areas (over and above the corresponding rural rate), retroactive to January 1, 2018. On a March 7, 2018 Open Door Forum, CMS indicated that it had updated the Medicare Ambulance fee schedule to reflect these higher rates, and that it has provided a Change Request to each of its Medicare Administrative Contractors (MACs). The AAA has confirmed that all MACs have successfully implemented the new rates, and that all are paying current claims at the correct rate. The AAA has further confirmed that MACs have started to adjust 2018 claims paid at the original (lower) rates. Unfortunately, neither CMS nor its MACs have committed to a firm timetable for the completion of all required adjustments; however, a number of MACs have...

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First Interim Evaluation Report on Medicare Prior Authorization

Talking Medicare: First Interim Evaluation Report on Medicare Prior Authorization (An 80-page report confirming what you already likely suspected) On February 28, 2018, the Centers for Medicare and Medicaid Services (CMS) posted an interim report on its prior authorization demonstration project for repetitive, scheduled, non-emergent ambulance transportation. The report, titled First Interim Evaluation Report of the Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT), was conducted by Mathematica Policy Research, a nonpartisan think tank. Mathematica studied the impact of the prior authorization model on Medicare payments, ambulance utilization, and patient quality of care. Background CMS implemented the prior authorization demonstration project in December 2014 in three states: New Jersey, Pennsylvania, and South Carolina (referred to in the report as “Year 1 States”). These states were selected based on higher-than-average utilization rates and high rates of improper payment for these services. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) subsequently expanded the demonstration project to five additional states (Delaware, Maryland, North Carolina, Virginia, and West Virginia) and the District of Columbia on January 1, 2016 (referred to in the report as “Year 2 States”). The goal of the demonstration project was to study the impact of...

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Statement for NBC Nightly News Balance Billing Story 3/9/18

Last night, NBC Nightly News with Lester Holt ran a segment on ambulance balance billing. Although provided with a brief one-paragraph statement in advance, they chose to use less than one sentence of it during the broadcast. We have reproduced our original statement below to provide additional context. For a better understanding of the forces driving the costs behind ambulance care, please see this recent longer media response by American Ambulance Association President Mark Postma. Video Story Original Statement Provided by American Ambulance Association Emailed to Eric Salzman on January 28, 2018 | Very brief due to TV news format Ambulance providers, both private and public, serve their communities with lifesaving on-demand mobile healthcare 24/7, regardless of patients’ ability to pay. Ambulance services are saddled with a high cost of readiness as they keep certified personnel, sophisticated technology, and costly medications ready round-the-clock. Medicare, Medicaid, and private insurance often reimburse ambulance services at rates below the costs of providing this care, endangering their ability to continue serving families in their time of extreme need. Ambulance services bill patients as a last resort: This necessity is driven by a complex combination of rising patient deductibles, reduced insurance coverage, and unfair contractual (more…)

Summary of March 2018 Ambulance Open Door Forum

CMS held its latest Open Door Forum on Wednesday, March 7, 2018. As with past Open Door Forums, CMS started the call with the following series of announcements: Medicare Fee Schedule – CMS indicated that the Bipartisan Budget Act of 2018, enacted on February 9, 2018, contained several provisions that impacted the payment of ambulance claims under the Medicare Ambulance Fee Schedule: Temporary Add-Ons for Ground Ambulance – CMS indicated that Section 50203(a) of the bill extended the temporary add-ons for ground ambulance services for an additional five years, retroactive back to January 1, 2018.  As extended, these add-ons will expire on December 31, 2022.  These add-ons increase Medicare’s allowable for ground ambulance base rates and mileage by 2% in urban areas, 3% in rural areas, and by 22.6% (over the applicable rural rate) for services provided in so-called “super rural” areas. Cost Reporting – CMS indicated that Section 50203(b) of the bill would require ground ambulance providers and suppliers to submit cost data to CMS. CMS noted that the new law requires CMS to develop, no later than December 31, 2019, a data collection system to collect cost, revenue, utilization, and certain other information related to ground ambulance services....

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CMS Issues Notice on Extension of Add-ons

The Centers for Medicare and Medicaid Services (CMS) issued a notice regarding the extension of Medicare provider provisions included in the Bipartisan Budget Act. The notice includes a paragraph with the details of the extension of the ambulance add-ons. The notice also states that “Medicare Administrative Contractors (MAC) will implement these changes no later than February 26, 2018 and will provide additional details on timelines for reprocessing or release of held claims impacted by these changes.”  As previously reported by the AAA, on February 14, CMS posted a revised Public Use File with the new Medicare ambulance fee schedule rates which include the 2% urban, 3% rural and super rural increases. We will keep you posted about any new developments about the reprocessing of previously submitted claims.  Questions? Please contact info@ambulance.org