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

Posted on by AAA Staff

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

Brian

Talking Medicare: A Good Thing Poorly Explained

Posted on by Brian Werfel

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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Brian

Update on Medicare Reimbursement Issues

Posted on by Brian Werfel

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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Brian

First Interim Evaluation Report on Medicare Prior Authorization

Posted on by Brian Werfel

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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Brian

Summary of March 2018 Ambulance Open Door Forum

Posted on by Brian Werfel

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

Posted on by AAA Staff

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

March CMS Ambulance Open Door Forum & Follow Up Q&A

Posted on by AAA Staff

The next CMS Ambulance Open Door Forum is scheduled for Wednesday, March 7 at 2:00 PM Eastern. Please dial in at least 15 minutes before the call. View Agenda. CMS Ambulance Open Door Forum March 7 | 2:00 PM ET 1-800-837-1935 Conference ID: 31612304 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 March 7 | 3:00 PM ET 1-800-250-2600 Pin: 73556603#

Brian

AAA Releases Updated 2018 Medicare Rate Calculator

Posted on by Brian Werfel

CMS Posts Updated 2018 Public Use File; OIG Guidance on Waiver of Small Cost-Sharing Balances Updated AAA 2018 Medicare Rate Calculator Now Available! The Centers for Medicare and Medicaid Services (CMS) has posted an updated version of the 2018 Medicare Ambulance Fee Schedule Public Use Files (PUF). These files contain the Medicare allowed base rate reimbursement amounts for the various levels of ambulance service and mileage rates. These files reflect the restoration, retroactive to January 1, 2018, of the temporary add-ons for ground ambulance services (2% for urban transports, 3% for rural transports, and the “super-rural” bonus) pursuant to the Bipartisan Budget Act of 2018, which was enacted on February 9, 2018. Accuracy of Rates and AAA Fee Calculator The American Ambulance Association has reviewed the rates in this file and confirmed that the rates are accurate. The AAA has also revised its Medicare Ambulance Rate Calculator to reflect the five-year extension of the ambulance add-ons as well as other policy changes including the two-year extension (2026 and 2027) of the 2% Medicare provider cut under sequestration and the additional 13% (23% total) cut to BLS nonemergency transports to and from dialysis centers. The additional dialysis transport cut takes effect...

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