CNBC | Why Ambulance Rides Are So Expensive In The United States

Thank you to American Ambulance Association Payment Reform Chair Asbel Montes for eloquently representing the EMS perspective on surprise coverage in this video from CNBC: It’s an open secret in America that calling for an ambulance can be a financial gamble because of surprise bills. There’s no way for patients to know how much an ambulance will cost before they get inside the vehicle, and the final bill can be thousands of dollars. Here’s why ambulances are so expensive in the United States and what can be done to change it.

Updated CMS FAQs on the Ambulance Data Collection

Updated CMS FAQs on the Ambulance Data Collection System and Reporting Requirement Delay As we recently reported, CMS announced that it will be delaying the implementation of the statutorily mandated ambulance data collection system.  CMS has released a new set of Frequently Asked Questions (FAQs) clarifying the delay.  In sum, ambulance organizations selected to provide cost data for 2020 will now be required to report 2021 data in Year 2.  CMS will also add a new set of ambulance organizations for Year 2 reporting as well.  This means that twice as many ambulance organizations will be reporting 2021 data in Year 2 and there will be no data reported for 2020.  Any organization selected that does not report data will be subject to the 10 percent penalty, unless an exception applies.  In addition to addressing concerns about reporting during the pandemic, the FAQs suggest that CMS is concerned that 2020 data “may not be reflective of typical costs and revenue associated with providing ground ambulance services.” The complete list of these questions, as well as previous ambulance FAQs for COVID-19 on Medicare Fee-for-Service (FFS) Billing can be found here.  The new data collections are below. Data Collection and Reporting Requirements (more…)

CMS Modifies the Cost Data Collection System Year 1 Data Collection

CMS has issued a blanket waiver modifying the data collection period for the ground ambulance services that were selected to report in Year 1.  Under the current law, these organizations would have been required to collect data beginning January 1, 2020, and through December 31, 2020.  The waiver allows these organizations to select a new continuous 12-month data collection period that begins between January 1, 2021 and ends December 31, 2021.  This modification means that such organizations will collect and report data during the same time period as the ground organizations that CMS will select for Year 2 of the cost collection program. From the summary of the waiver, it appears that organizations will have the choice of submitting data in Year 1 or Year 2.  CMS has not moved the timeline for any other data collection year, so there is the potential for a substantial number of organizations to report in Year 2, which would increase the amount of data available. The AAA has supported the data collection system to make sure that CMS and the Congress have valid and reliable data to support maintaining the geographic add-ons to the Medicare Ambulance Fee Schedule and to support efforts to...

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CMS Issues Additional Staffing and Licensing Waivers

On May 1, 2020, CMS updated its “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing.”  The full document can be viewed by clicking here. In the updated FAQ, CMS answers three important questions related to ambulance vehicle and staffing requirements: Expired Ambulance Operating Licenses. CMS was asked whether a ground ambulance vehicle operating under an expired license could nevertheless satisfy the Medicare regulations related to vehicle licensing.  CMS indicated that the ground ambulance would remain in compliance with Medicare Program rules to the extent it was permitted to operate without a renewed license under a valid state or local law, regulation, or legally adequate waiver.  It is important to note that this is not a “waiver” of CMS rules per se.  Rather, CMS correctly noted that additional flexibility being provided is based on the state waiving or relaxing its existing rules related to licensures. Modified Staffing Requirements. CMS was asked whether an ambulance service that staffs its vehicles with personnel that fall below the previously required levels of certification would be in compliance with Medicare Program rules.  The Medicare regulations at 42 C.F.R. §410.41(b) set forth the requirements for vehicle staffing.  These regulations largely defer to state and...

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COVID-19 Uninsured Program Now Includes Air, Water

HHS Updates Guidance on Provider Relief Funding for Uninsured to include Air and Water Ambulance The Department of Health and Human Services recently updated its guidance on the disbursement of provider relief funds under the CARES Act for the testing and treatment of the uninsured.  Previously, HHS indicated that this allocation was only available for the reimbursement of emergency and non-emergency ground ambulance transportation.  However, in its most recent update, HHS has removed the restriction that limited participation to ground ambulance providers and suppliers.  The new guidance indicates that the relief funds are now available for all emergency ambulance transportation and non-emergency patient transfers via ambulance. Thus, it appears that air and water ambulance providers and suppliers are now eligible to receive funding for the treatment of COVID-19 patients.  Is there anything my air or water ambulance organization needs to do to claim reimbursement for treatment of uninsured COVID patients? Yes.  In order to be eligible for payments for the treatment of uninsured COVID patients, you must enroll as a participant in the program.  Enrollment must be done through an online portal that can be accessed at: http://www.coviduninsuredclaim.hrsa.gov. Once my organization enrolls, when can we start submitting claims for reimbursement...

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AAA Sends COVID-19 Relief Request Letter to President Trump

On April 28, the American Ambulance Association sent a letter to President Donald Trump with four requests as to how his Administration can best help ground ambulance service providers mitigate the COVID-19 pandemic. The AAA requested the following: Increase Financial Assistance Related to COVID-19 for Ground Ambulance Services Increase the percentage of the general allocation of funds under the Public Health and Social Services Emergency Fund (PHSSEF) for ground ambulance services providers and suppliers to equal a total of $2.89 billion in funds for our industry. The $2.89 billion reflects $48,000 per ambulance with an estimated 60,000 registered vehicles. We greatly appreciate the recent payments under the Fund which will help with our current situation. However, the ground ambulance services industry is only 0.90% of Medicare fee-for-service annual outlays which resulted in $270 million for our industry in round one of PHSSEF payments. This figure is disproportional to the large role of ground ambulance service providers and suppliers in responding to COVID-19 and our increased costs and reduced revenues during the PHE. Priority Access for Paramedics and EMTs to PPE, COVID-19 Testing and Tax Relief Protect paramedics and EMTs by directing federal agencies to provide them with higher priority access...

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COVID-19 Financial Impact Calculator

The American Ambulance Association is working nonstop on advocating for financial relief from the impact of the Coronavirus (COVID-19) for our members. Now that ground ambulance service providers and suppliers are receiving federal funding to help partially offset the negative financial impact of the Coronavirus (COVID-19), the Congress is asking for information to substantiate that additional funding is necessary. Instead of providing just anecdotal information on the increased costs and lost revenue from COVID-19, we need to provide more wide-ranging data demonstrating the dire financial situation facing our industry. To this end, the American Ambulance Association has developed a Financial Impact Calculator to gather information from our members to help us make our case for additional financial relief. The Calculator is also designed for members to use in completing the application for more funding under the General Allocation second distribution of the Public Health and Social Services Emergency Fund. Download the  Excel Version of the Financial Impact Calculator as a reference. The Instructions include definitions for fields in both the Excel and online calculators. Your data will be safely stored, and will  be shared only in aggregate. Please DO NOT enter commas or dollar signs  when providing data. The system will (more…)

HHS Provider Relief Tranche 2 Calculator

Use the American Ambulance Association’s simple form to estimate relief you may receive from the second tranche of HHS COVID-19 funding. Please note that not all providers will receive funds. More information about this program as well as access to the form you must complete in the General Allocation Portal can be found on the HHS website. For-profit and non-profit non-governmental providers,  to determine your Net Patient Revenue for the portal, use the following information from your most recently filed tax return. (2019 if filed, otherwise use 2018 numbers). Governmental providers,  enter your revenue generated for the last audited financial year. When completing the form in the portal,  select Tax Exempt Organization. When asked to upload a return at the end, upload your most recent audited financials. Please do not enter commas or dollar signs. A negative number or zero in the Tranche 2 box indicates that you WILL NOT receive funding in tranche  2....

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AAA Sends Letter Requesting Priority Testing for EMS

AAA Sends Letter to Requesting Priority Testing for First Responders Earlier today, the AAA sent a letter to the U.S. Public Health Service (USPHS) requesting that first responders with COVID-19 symptoms be given priority one status in the order of groups to be tested for COVID-19. The USPHS had issued guidance that assigned first responders a level two status. The AAA stated paramedics and EMTs should be included in the top level with other health care professionals who are on the front lines of caring for patients with COVID-19.  Read the Letter HERE.  ...

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