AETNA/CVS Deal Along with Uber Concepts May Finally Change Ambulance Industry

Mark Postma, AAA President & Asbel Montes, AAA Payment Reform Chair The recent merger of Aetna/CVS may be the catalyst that finally brings the change that the ambulance industry has been advocating for over the past several years. This new healthcare strategy supports the ambulance industry’s ideas that alternative patient destinations are needed in EMS. To explain this better, one must understand the current state of ambulance reimbursement via the 911 system or equivalent. At this point in time most commercial payers of healthcare (Insurance) as well as Medicare will not pay for 911 ambulance transportation to any destination other than the “nearest appropriate” hospital based emergency room; arguably, the most expensive and least efficient form of healthcare. The continuation of this policy discounts the advanced capabilities of both EMS and new clinical settings and the savings that can be achieved through innovative change. In addition, at the same time that the cost of healthcare in general is increasing, reimbursement from all payers is decreasing, creating a significant challenge for providers. Medicare consistently pays providers below cost for providing life-saving services and state Medicaid agencies are consistently underfunding the critical services to the un- and under-insured populations that have allowed (more…)

Balance Billing: AAA EVP Maria Bianchi on WOSU Ohio

The American Ambulance Association continues to defend ambulance providers in the face of misunderstandings regarding balance billing. Today, AAA’s Executive Vice President Maria Bianchi provided context on WOSU’s All Sides with Ann Fisher. Maria called in during an interview with Melissa Bailey, author of the November 20 Kaiser Health News article to which association President Mark Postma recently responded. Maria’s comments helped listeners understand the complex reality of EMS funding. Listen on-demand now►

Response to Kaiser Health News Ambulance Billing Article

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…)

Patient Satisfaction and the Collections Conundrum

Emergency Strikes The year was 2001—seems like a distant memory. Expecting our first child, my wife and I were living in Modesto, California, thinking about cradles and nurseries. We were so excited—the little one we’d been expecting was on his way! Excitement quickly changed to deep concern as we learned there were some major complications with the pregnancy and our baby was in serious jeopardy. Life’s pause button was pushed as everything else in the world came to a screeching halt. An ambulance transport and emergency delivery later, we found ourselves in our new home—the neonatal intensive care unit. For the next four months, we worked with medical teams around the clock to slowly usher our new 1-pound, 4-ounce son, Noah (now 15 years old), into the world. Financial Domino Effects This was an incredibly stressful time in our lives. Of all the things that burdened us, one of the most memorable was the nearly $5,000 invoice we received for a specific service. With no clue how we would pay this, I finally worked up the courage to pick up the phone and call the number on the invoice. The provider was demanding immediate payment before sending the bill to...

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UnitedHealthCare Denials for ALS-2 Claims

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...

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Administration’s Proposed Rule on Marketplace Stabilization

The Centers for Medicare & Medicaid Services (CMS) has released the “Marketplace Stabilization Proposed Rule” (Proposed Rule). Overall, the rule proposes a series of modifications to the Marketplaces that align with requests made by issuers in an attempt to keep them in the Marketplaces. The background section of the Proposed Rule emphasizes the concerns of issuers and the Agency’s interest in making sure that consumers have more plan options for 2018. Comments are due March 7. While ambulance services are not directly mentioned, the Proposed Rule could affect the ability of individuals in the marketplace to enroll and remain enrolled in plans. Another provision that could impact the ambulance industry is the proposal to rely more upon the States to enforce the network adequacy requirements of the ACA.   Changes to Open Enrollment/Special Enrollment Periods CMS proposes to tighten the enrollment rules in several ways. First, the Proposed Rule would change the open enrollment period to November 1 – December 15 to “increase the incentives for individuals to maintain enrollment in health coverage and decrease the incentives for individuals to enroll only after they discover they require services.”[1]  Individuals may still be eligible for a special enrollment period that would allow...

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WTAE Shows 25% of Ambulance Calls Unpaid

WTAE Pittsburgh’s Action News recently published a great video investigative piece by Paul Van Osdol on the realities of ambulance funding. So who pays for these and other non-transport calls? “The folks that go to the hospital end up paying for the 25 percent that we don’t transport,” Porter said. But even that does not cover the entire cost, and as a result, ambulance companies are hurting. “That is frightening when you think about the EMS system as a whole,” Porter said. “The risk is burnout of EMS crews, overworked EMS crews, delayed response time, inadequately trained staff.” Read the full article, and see their fantastic video, over at WTAE.com.