The next CMS Ambulance Open Door Forum is scheduled for Thursday, December 14 at 2:00 PM Eastern. Please dial in at least 15 minutes before the call. View Agenda. CMS Ambulance Open Door Forum December 14 | 2:00 PM ET 1-800-837-1935 Conference ID: 61764351 Questions? Have questions after the CMS Open Door Forum? 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 December 14 | 3:00 PM ET 1-800-250-2600 Pin: 82802314#
To the Editor: I write today in response to Melissa Bailey’s November 20 piece about ambulance balance (“surprise”) billing. While we disagree with the characterization of ambulance services in the article, we welcome the ongoing public dialogue about how unsustainable reimbursement for emergency medical services results in cost-shifting to patients. Missing from the article is a true understanding of the sky-high cost of readiness for emergency medical services. Ambulance service providers offer their communities 24/7/365 on-demand mobile healthcare. Skilled staff and ambulances—high-tech emergency rooms on wheels—are ready to respond to a 9-1-1 call at a moment’s notice to help patients with issues ranging from stroke to heart attack to trauma to childbirth. EMS is also on the very front lines of the surge in opioid overdoses, providing naloxone (Narcan) to hundreds of patients each day. Keeping supplies, medications, equipment, and personnel at-the-ready requires a significant ongoing investment, regardless of whether or not an ambulance is out responding to a call. Cost comparisons between EMS and the rideshare app Uber may make for catchy sound bites, but they are misleading and misguided. The piece states that our nation’s 14,000 ambulance service providers received 1,200 Better Business Bureau complaints spread over three (more…)
When discussing this new and growing field of pre-hospital care, there seems to be two unique paths that services are following. The first is the hospital-owned or contracted service, where community providers seek ways to decrease readmission rates for CHF, COPD, Pneumonia, Sepsis, MI and other chronic illnesses. When a patient discharged with one of these targeted conditions is readmitted within a 30 day window, “hospitals face penalties of up to 3 percent of Medicare payments in 2018” (Gluck, 2017, para. 10). That is a lot of money. Consider, “Lee Health, Southwest Florida’s largest hospital operator, which is expected to lose $3.4 million in payments” (Gluck, 2017, para. 2). This model represents the if, or, and type of service, meaning if we can do it for less and there are providers willing to do this type of medicine, then we can save the expensive penalties from CMC. The other model of community paramedicine is 911 abuse reduction. For years EMS has conditioned the public to call 911 for any emergency. But today, what we consider an emergency is far from the public’s perception of an emergency. “EMS has experienced a 37% increase in 911 calls since 2008.” (White, 2016, para. (more…)
The next CMS Ambulance Open Door Forum is scheduled for Thursday, September 14 at 2:00 PM Eastern. Please dial in at least 15 minutes before the call. View Agenda CMS Ambulance Open Door Forum September 14 | 2:00 PM ET 1-800-837-1935 Conference ID: 61073419
Medicaid billing in emergency medical services is unavoidable. From trauma trips to non-emergency transports, ambulance providers face a multitude of hurdles when trying to identify, verify and bill the correct payor for Medicaid patients. Guesswork is often used instead of real-time insurance verification. This can be especially true when commercial payors such as United Healthcare and Blue Cross Blue Shield manage the Medicaid plan, commonly termed Medicaid Replacement Plans. This article provides four valuable tips for successfully processing EMS claims when a Medicaid Replacement Plan is involved. The Challenge for EMS Billing: Benefits Verification Just as commercial payers see growth opportunities in managing Medicare Advantage (MA) plans, they are also overseeing hundreds of Medicaid programs. According to the annual CMS-64 Medicaid expenditure report, in federal fiscal year (FFY) 2016, Medicaid expenditures across all 50 states and 6 territories exceeded $548 billion, with nearly half of all spending now flowing through Medicaid managed care programs. On average 54.67% of Medicaid dollars are spent on managed care, whether to manage the transition or fund plans. This ranged from 97.9% in Puerto Rico, down to 12.1% in Colorado. A single trip may have Medicaid benefits, but also managed by United Healthcare or another (more…)
From Akin Gump: The Congressional Budget Office (CBO) this afternoon released its cost estimate of the Senate’s health care bill, the Better Care Reconciliation Act (BCRA), projecting that the legislation would increase the number of uninsured by 22 million in 2026 relative to the number under current law. This is slightly fewer than the number of uninsured estimated for the House-passed American Health Care Act (AHCA). CBO also estimates that the BCRA would reduce federal deficits by $321 billion over 10 years, $202 billion more than estimated net savings for the House bill. According to the Senate Budget Committee, below is a brief summary of the changes that were made to the previous draft: Conforming amendments to Sec. 106 – Changes made to better align the purposes of stability funding to the underlying CHIP statute. Adds a new Sec. 206 – Starting in 2019, individuals who had a break in continuous insurance coverage for 63 days or more in the prior year will be subject to a six month waiting period before coverage begins. Consumers will not have to pay premiums during the six month period. Redesignates Secs. 206-208 to Secs. 207-209, to accommodate for the new Sec. 206 on (more…)
CMS has issued an MLN Ambulance Transports Booklet. The booklet (36 pages) can be downloaded here. One section of the Booklet that you might want to keep handy involves Free-Standing Emergency Departments. Specifically, on page 15, CMS states the following: Freestanding Emergency Department (ED) If a freestanding ED is provider based (a department of the hospital), the ambulance transport from the freestanding ED to the hospital is not a separately payable service under Part B if the beneficiary is admitted as an inpatient prior to ambulance transport. For more information about criteria for coverage of ambulance transports separately payable under Part B or as a packaged hospital inpatient service under Part A, refer to Chapter 10, Section 10.3.3, of the Medicare Benefit Policy Manual. This may be useful, along with the Manual section cited, when you have a free-standing ED that is part of a hospital and they call for transports to the main building for the patient to be admitted, but the hospital lists the time of admission as being prior to the time of your transport. When the hospital admits the patient prior to your transport, the hospital becomes responsible for the ambulance charges. It may be useful to show the hospital...
Talking Medicare with Brian S. Werfel, AAA Medicare Consultant Over the past few weeks, we have received emails from ambulance providers across the country reporting that UnitedHealthCare (UHC) has started to deny claims for the ALS-2 base rate. Affected claims include both commercial and Medicare Advantage claims. These providers are reporting that UHC is requiring the use of Current Procedural Terminology (CPT) Codes to support the ALS-2 level of service. When these providers call UHC to question the denials, the customer service representative refers them to UHC’s online policies and procedures manual. The section of that manual devoted to the ALS-2 base rate largely mirrors Medicare’s definition. For example, it indicates that ALS-2 can be billed based on three separate administrations of one or more medications by IV push/bolus or continuous infusion, or upon provision of one or more of the designated ALS-2 procedures (e.g., an endotracheal intubation). However, the manual section then goes on to indicate that “Ambulance Providers or Suppliers are required to report CPT or HCPCS codes… when reporting A0433. Ambulance transport services that do not include the services described in criteria 1 or 2 above should be reported with a more appropriate ambulance transport code.” The...