GSA KKK | Ambulance Vehicle Standards Change

KKK-A-1822F AMBULANCE STANDARD UPDATES WEIGHT AND PAYLOAD REQUIREMENTS   KKK Change Notice #13 went into effect on July 1, 2020. This annual revision included a variety of updates as usual.  However, this particular notice included a significant change to the longstanding KKK specifications for vehicle weight and payload capacity. Specifically, the GSA has modified the…

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NAAC Live 2020 Offers All Four Certification Courses

NAAC Live 2020 Offers All Four Certification Courses with Live, Real Time Instruction

 

Press Release Contact:  
Jason Leet, Program Coordinator at 717-620-2692
j.leet@AmbulanceCompliance.com

NAAC® – The National Academy of Ambulance Compliance for the first time ever is hosting all four NAAC certification programs at one virtual event – live and in real time – over two weeks in September.  Each course features live instructors that will answer questions in real time.  “These live courses offer an unparalleled opportunity to obtain all NAAC ambulance certification credentials in a dynamic and interactive setting,” said program coordinator Jason Leet.  “Course enrollees will get all their questions answered live,” Leet said.

NAAC Live 2020 is different from the traditional, self-paced online courses offered by NAAC, according to Leet. During NAAC Live 2020, the courses will be presented live on specific class schedules:

Certified Ambulance Compliance Officer™ – CACO®
September 9 through 10, 2020

Certified Ambulance Coder® – CAC®
September 14 through 16, 2020

Certified Ambulance Privacy Officer™ – CAPO®
September 21 through 22, 2020

Certified Ambulance Documentation Specialist™ – CADS® –
September 24, 2020

There is a registration fee for each course, which includes all course educational materials and includes the testing and certification process.  Click HERE to register or obtain additional information.

“This schedule allows attendees to obtain all four of our certifications in a two-week time span as courses are staggered so there is no overlap,” added Leet. Instructors are attorneys and consultants of the national EMS law firm of Page, Wolfberg & Wirth, LLC, the nation’s leading EMS law firm – experts in ambulance industry compliance. In addition to the live instruction, course enrollees will have immediate access to each final exam, and there will be instant certification upon completion and passing the exam, said Leet.

About the Courses

The CAC course is designed for ambulance billing personnel – anyone involved in the ambulance revenue cycle. This includes front line ambulance billers and coders, billing office supervisors and managers, compliance officers, QA coordinators and upper level management in an ambulance service, billing company or any other entity involved in ambulance billing, reimbursement, or revenue cycle management.

The CACO course is recommended for current and prospective compliance officers, upper level management, advanced billers and coders, and anyone involved in compliance training or supervising compliance with the ambulance billing company or agency.

The CAPO course is designed for the prospective HIPAA Compliance Officer/Official, Privacy Officer, security officers, managers, supervisors, and others involved in HIPAA training or compliance.

The CADS course is intended for front-line EMS practitioners, as well as ambulance industry leadership, revenue cycle management, compliance, quality improvement and other support positions. The CADS course covers the essential documentation skills necessary to facilitate high quality patient care, reduce provider and agency liability, improve clinical documentation, and facilitate accurate billing.

About NAAC

NAAC – The National Academy of Ambulance Compliance – is the nation’s leader in ambulance compliance education. NAAC represents the industry’s “Gold Standard of Excellence” in compliance, ethics, and legal integrity in all facets of ambulance compliance. NAAC provides premier training and education to ambulance billing, coding and compliance professionals and EMS practitioners through its four certification programs.

NAAC-certified professionals maintain their competency through annual continuing education requirements. NAAC provides and accredits a wide range of continuing education programs throughout the year, both in classroom and online offerings.

Certified individuals – including those obtaining certifications during NAAC Live 2020 – can meet all their annual required continuing education requirements by attending the PWW XI/abc360 conferences, to be held October 20-22, also as live, virtual events.  CLICK HERE for information about the Fall Conference.

More detailed information on NAAC and its ambulance industry certification courses can be found online at www.AmbulanceCompliance.com.

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COVID-19 Testing for First Responders

From the Federal Healthcare Resilience Task Force’s EMS / Prehospital Team on July  2.

COVID-19 Testing for First Responders

Product (EMS42) Purpose

This document provides a brief overview of COVID-19 testing to inform decision-making for first responders including emergency medical service (EMS), Fire & Rescue, Law Enforcement and 911 telecommunicators.

Developed By

The Federal Healthcare Resilience Task Force (HRTF) is leading the development of a comprehensive strategy for the U.S. healthcare system to facilitate resiliency and responsiveness to the threats posed by COVID-19. The Task Force’s EMS/Pre-Hospital Team is comprised of public and private-sector EMS and 911 experts from a wide variety of agencies and focuses on responding to the needs of the pre-hospital community. This team is composed of subject matter experts from the National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services (OEMS), National 911 Program, Federal Emergency Management Agency (FEMA), U.S. Fire Administration (USFA), U.S. Army, U.S. Coast Guard (USCG), Department of Homeland Security (DHS) Cybersecurity and Infrastructure Security Agency (CISA) and non-federal partners representing stakeholder groups. Through collaboration with experts in related fields, the team develops practical resources for field providers, supervisors, administrators, medical directors, and associations to better respond to the COVID-19 pandemic.

Intended Audience

State, Local, Tribal, and Territorial Governments (SLTTs), First Responders (Law Enforcement, Fire & Rescue, Emergency Medical Services (EMS) and 911 communication personnel).

Expected Distribution Mechanism

EMS.gov, Stakeholder Calls, EMS stakeholder organization’s membership distribution Email mechanisms, USFA website, Social Media posts. Request assistance distributing to FEMA/HHS RECs

Internal Routing Review

NRCC (for approval), All ESFs and HCRTF Teams & Threads (for SA only)

Primary Point of Contact

NHTSA Office of EMS, nhtsa.ems@dot.gov, 202-366-5440

Date Published: July 2, 2020

COVID-19 Testing for First Responders

Purpose: This document provides a brief overview of COVID-19 testing to inform decision- making for first responders including emergency medical service (EMS), Fire & Rescue, Law Enforcement and 911 telecommunicators.

1. Overview of testing for SARS-CoV-2 (the virus that causes the disease COVID-19):

The Food and Drug Administration (FDA) is the U.S. government entity responsible for regulating medical devices, including tests and devices like those being used to detect SARS-CoV-2. Because of the public health emergency caused by a previously unknown novel coronavirus, the FDA has issued multiple Emergency Use Authorizations (EUA) for various types of medical devices, including tests. Final validation of these tests still need to be completed through all of the normal FDA clearance criteria and received approval or clearance by the FDA under the traditional marketing pathways approval processes at this time. A list of tests which have been issued EUAs is available at EUA Information: gov.

2. Types of Testing:

  • Molecular: The molecular diagnostic tests look for evidence of an active infection by detecting either the genetic material of the pathogen or a unique marker of it. This type of test detects signs of the virus’s genetic material. One type of molecular testing uses is called a reverse transcriptase – polymerase chain reaction (RT-PCR) for pathogen detection. This approach requires only a small sample size of the pathogen (ex. from blood or saliva) and amplifies segments of the virus’ genetic code and replicates it in order to be show it is present more easily detected. A positive result indicates the presence of actual infectious viral material in the body. However, these results cannot alone determine if the pathogen remains viable (e.g., infective) or is dead and no longer infective. The presence of such material does not necessarily indicate if the patient is infectious (although for provider safety, patients with a positive test should be presumed infectious) but simply that such material is there. Test samples are usually obtained from humans using a special nasal swab designed for this
  • Antigen: The antigen diagnostic tests quickly detect fragments of pathogen proteins found on or within the virus from testing samples collected from humans, often from a swab of the nasopharyngeal cavity using swabs. However, antigen tests may not detect all active infections. Antigen tests are very specific for the virus but are often not as sensitive as molecular RT-PCR tests because of the certainty of positive samples used to develop the actual test. This means that while positive results from antigen tests are generally highly quite accurate, but there is also a higher chance of false negatives – which means falsely claiming absence of infection, thus negative results do not rule out infection. Until well-validated antigen testing is available, negative results from this approach may warrant confirmatory testing using a molecular test (i.e. an antigen test may need to be confirmed with a RT-PCR test prior to making treatment decisions or to help prevent the possible spread of the virus due to a false negative).
  • Serological: The serology tests look for the presence of antibodies, which are specific proteins made in response to an infection as part of the body’s attempt to fight that infection. It does not specifically indicate current (active) disease. It is important to remember that development of antibodies takes some time to develop after exposure to the infection, usually weeks. There are also different types of antibodies that are developed and can be tested for individually (ie. IgG, IgM). Depending on when someone was infected and the timing of the test, antibodies may not have developed in sufficient quantities to be detected by the test. We currently don’t know if detection of antibodies, and at what level, indicates immunity, and/or protection, from a future exposure. Similarly, there is also, another concern that any detected antibodies may instead reflect other strains of a more commonly occurring coronaviruses, such as those causing which causes some variations of the common

3. Testing Limitations: No test is 100% accurate 100% of the time.

  • Specificity: Specificity is a measures of a test’s ability to correctly generate a negative result for people who don’t have the condition that’s being tested for (also known as the “true negative” rate). A high-specificity test will correctly rule out almost everyone who doesn’t have the disease when the test is negative and won’t generate a high percentage of false-positive results. (Example: a test with 90% specificity will correctly return a negative result for 90% of people who don’t have the disease but will return a positive result — a false-positive — for 10% of the people who don’t have the disease and should have tested negative – which is termed a false positive )
  • Sensitivity: Sensitivity is a measures of how often a test correctly generates a positive result for people who have the condition that’s being tested for (also known as the “true positive” rate). A test that’s highly sensitive will identify almost everyone who has the disease and not generate many false-negative results. (Example: a test with 90% sensitivity will correctly return a positive result for 90% of people who have the disease but will return a negative result — a false-negative — for 10% of the people who have the disease and should have tested positive, or a false )
  • There are currently a variety of tests which have not been reviewed by FDA but may be purchased to test for COVID-19. The concern with false negatives relates to the higher potential for future transmission whereas the concern for a false positive relates to unnecessary additional diagnostic or medical procedures for the patient and wasted unnecessary PPE use for the provider and a false negative result could lead to additional exposure to contacts of the patient, including first responders and EMS personnel.

4. Testing Evaluation Tips:

Testing for first responders and EMS clinicians should be coordinated with the EMS Medical Director and other local/state public health

Check the FDA site (COVID-19 Testing EUA Recipients ) to determine whether the test you are considering purchasing has received an EUA by the

Work with the EMS Medical Director to identify the test error rate to determine whether the results can be relied upon and if actions can be made with the data

Purchase tests only through verified suppliers to ensure authenticity. There have been reports of counterfeit tests being sold to unsuspecting

Follow the test instructions exactly to avoid increasing the error rate and to achieve full test performance. Use Clinical Laboratory Improvement Amendments (CLIA)-certified labs for test processing, if required based on the specific

5. Research References:

CDC Serology Testing: https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html

Emergency Use Authorizations: https://www.fda.gov/medical-devices/emergency-use- authorizations-medical-devices/coronavirus-disease-2019-covid-19-emergency-use- authorizations-medical-devices

FAQs on Diagnostic Testing for SARS-CoV-2: https://www.fda.gov/medical-devices/emergency- situations-medical-devices/faqs-diagnostic-testing-sars-cov-2

FDA Contact Information on Testing:

FDA Statement Regarding COVID-19 Antigen Testing: https://www.fda.gov/news-events/press- announcements/coronavirus-covid-19-update-fda-authorizes-first-antigen-test-help-rapid- detection-virus-causes

Serology Test FAQs: https://www.fda.gov/medical-devices/emergency-situations-medical- devices/faqs-diagnostic-testing-sars-cov-2#serology

CDC recommendations for the Testing of COVID 19: https://www.cdc.gov/coronavirus/2019- ncov/symptoms-testing/testing.html

Infectious Disease Society of America (IDSA) primer on serological testing : https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody- testing-primer.pdf*

Guidance on Interpreting COVID-19 Test Results: https://www.whitehouse.gov/wp- content/uploads/2020/05/Testing-Guidance.pdf

CISA Guidance on Essential Critical Infrastructure Workers

ADVISORY MEMORANDUM ON IDENTIFICATION OF ESSENTIAL CRITICAL INFRASTRUCTURE WORKERS DURING COVID-19 RESPONSE As the Nation comes together to slow the spread of COVID-19, on March 16th the President issued updated Coronavirus Guidance for America that highlighted the importance of the critical infrastructure workforce. The Cybersecurity and Infrastructure Security Agency (CISA) executes the Secretary of Homeland…

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Savvik | Clarity COVID-19 IgG/IgM test kits

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New Benefit: Kindercare Discount & Priority Placement

AAA understands that EMS staff often experience significant challenges securing quality, reliable childcare, and that these challenges have been exacerbated by school and daycare closures caused by COVID-19. We are here to help!

The American Ambulance Association is proud to share that we have partnered with Kindercare to offer EMS providers priority childcare placement as well as a 10% discount on tuition. Please share this information with your staff! Visit www.kindercare.com/aaa for full details.

Kindercare Locations

AAA member employee families receive priority placement at all 1600 Kindercare centers, including the 400 Essential Care Centers that remain open during the pandemic.

Childcare Services & Age Range

AAA member employees save 10% on full-time, part-time, and drop-in tuition for children ages six weeks to 12 years at any KinderCare Learning Center or Champions before- and after-school sites nationwide.

Existing  Kindercare Families

This offer is available to new families as well as those already enrolled in a participating center.

Tuition Discount Guide

  1. Search for a center or site that is near you (Search Essential Centers Open During COVID-19 | Search All Centers, Including Those Currently Closed)
  2. Schedule a tour of the center or site online or by phone with the center information provided.
  3. When you enroll (or if you’re already enrolled), let your Center Director know you are a member of American Ambulance Association and that you are eligible for a 10% tuition benefit.
  4. Your Center Director will apply the discount on your next billing cycle.

 

Webinar Materials & FAQ: Claims Guidance for COVID-19

Webinar: How to Best Document and Track Claims Related to COVID-19

Recorded: Thursday, March 26th | 12:00pm Eastern
View On-Demand Recording
View PPT Slides

FAQ of unanswered webinar questions:

  1. Is the idea that the ET3 model will be pushed to all ambulance companies or only previously selected participants?

The request into CMS and leadership during the declared public health emergency is to allow all ambulance providers and suppliers to transport patients or treat in place based upon the concepts outlined in the Emergency Triage, Treatment and Transport model as defined by CMMI’s release last year.

  1. While we wait for finalization of the ET3 protocols, will billing be allowed retroactively?

If CMS follows other waiver provisions that they have been approving, then we would expect the waiver to be retroactive. However, that will be clearly identified when and if the final waiver is approved.

  1. Asbel spoke about Telehealth medical necessity, which we assume applies to the QHP.  Neither CMS nor the MAC has provided any guidance regarding MN guidance for the ambulance that is facilitating the telehealth.  CMS ET3 FAQ provides a non-answer. Can you advise?

You will need to understand the nuances around telehealth and what Medicare requires as a covered benefit for telehealth. Please see attached resources below

  1. Do we need to file an application for TIP?

That is unclear at this time. The AAA has been advocating for national policy that would not include an application process during this public health emergency. If CMS accepts our proposal, then we do not expect an application process.

  1. Will Medicare pay for signs and symptoms such as a cough that is not on our LCD list?

The Centers for Disease Control and Prevention (CDC) has established new codes related to COVID-19.  They are available in this link:  https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

  1. How can we bill for lift assists and basically public assist? For example, we are seeing increased med alarm pulls because in some of the senior assisted living or independent with aide service, the aide staff is not showing up or is late.  We are getting 911 calls for help getting dressed, move me from my chair to bed at night, etc. (We have one building with many PACE participants, so many Medicare primary)

Yes, you can bill for any response. I am assuming you are looking to understand who the payer source will be for those responses. Currently, Medicare does not pay for an ambulance response without a subsequent medically necessary transport to a covered destination.

The lift assist and public assist responses may be billed to whoever the caller source is if there is no state or local law that prohibits this practice.

Suggestion: You could work with your state legislature or local governing body to codify in statute or local ordinance the responsibility for these false alarms, or public assists are the responsibility of the requestor and invoke penalties if not paid. There are many local jurisdictions that codify this in law with prescribed penalties to try and deter this abuse.

  1. How does this impact the patients who typically are transported by sedan cars or gurney vans to dialysis, but now are confirmed COVID-19 or suspected and still need to be transported to Dialysis? Gurney Van or Sedan cars don’t have the isolation precautions to transfer those patients. Can those patients now be transported by BLS Non-Emergency ambulance?

Medicare has not changed its requirements for transporting beneficiaries to/from dialysis facilities.  We understand that some MACs recognize as a primary reason for ambulance transport patients who have a communicable disease or hazardous material exposure and must be isolated from the public or whose medical condition must be protected from public exposure.  Some MACs do not view this condition as a primary reason to transport a patient, however.  The AAA is seeking clarification from CMS to try to align MACs around the view that patients who require isolation because of a communicable disease or hazardous material exposure can be transported by ground ambulances.

  1. There is already an “I” origin/destination modifier for the site of transfer between modes of ambulances. Wouldn’t this new “I” confuse things?

Great question. Yes. We will wait and see final direction from CMS if they approved transport to a COVID-19 testing site.

  1. Does the use of the “I” modifier include a site such as a shelter that might be set up for COVID-19 patients? Specifically I am referring to a site that maybe the state or local authority has set up and is not directly tied to a hospital.

Yes, that is the waiver that we are seeking from CMS. They could recommend a different modifier. It should be noted that States do have the authority to request a waiver to allow for this, as well. You do not have to wait on the CMS.

  1. The ICD 10 codes related to COVID19 are not effective until April 1st. Once effective, can they be used on a run that occurred before that date?

On February 20, 2020, the Centers for Disease Control and Prevention issued guidance on the ICD-10 codes that should be used. You can find this guidance at the following site:

https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

  1. Is there anything on the end user if ambulance personnel need to document differently for billing purposes?

Best practices would be to provide instruction or edits within your PCR that identifies the following: (1) COVID-19 suspected or positive patient; (2) PPE equipment used (not just a general statement); and (3) any other pertinent information related to the inability to sign any forms due to local or state mandates.

Due to circumstances surrounding this national emergency that we have not experienced before, things are constantly changing. Documentation will be the CRITICAL in helping to obtain additional federal, state and local waivers. Accurate and reliable documentation will be key in building the case retrospectively.

  1. Have there been any signature requirement changes due to COVID 19?

CMS has provided the following guidance:

“At this time, suppliers should do their best to obtain proof of delivery and should notate the file that the beneficiary declined to sign.  Where FedEx or similar delivery services have altered their delivery protocols (such as leaving packages at the home without signatures) due to the COVID-19 pandemic, CMS will consider the revised protocols if conducting review absent suspicion of deliberate gaming or attempted fraud.  Suppliers should continue providing the necessary supplies and document the proof of delivery to the best of their ability (such as a picture of the delivery and/or notation in the file). “

  1. Do any of the waivers apply to the patient signature requirement? Are there links or support for how to learn about 1135? How do we know what our state has done regarding 1135 waiver? How do we work with our state to expand services via 1135 waiver?

The link below is a great tutorial on how 1135 waivers work and tracking existing waivers.

https://www.kff.org/medicaid/issue-brief/medicaid-emergency-authority-tracker-approved-state-actions-to-address-covid-19/

The health agency in your state would be your POC to engage regarding ambulance requests for expanded services via the 1135 waiver.

  1. Is there a specific documentation on the HCFA form’s for using the 1135 waiver?

Each payer is issuing specific claims guidance on how to bill for waived services through the 1135. You will need to check with your state Department of Insurance or Medicaid Agency. They should have resources online to assist you with identifying what specific documentation is needed.

  1. Has there been any discussion in the delay of Data Collection?

No.  At this point the program remains underway.  The first set of services required to submit were notified at the end of 2019.  CMS continues to develop the tool it will use to collect the data, which we expect to see later this summer or early fall.  However, if the pandemic continues, we will engage with CMS to determine how they view data collection.

If you have an additional questions, please email the AAA at info@ambulance.org

Presenters:

Asbel Montes
Senior Vice President of Strategic Initiatives and Innovation, Acadian Ambulance Service

Asbel has been a member of the American Ambulance Association (AAA) for eight years and has served on its Board of Directors; he currently is Chair of the Payment Reform Steering Committee. Asbel also sits on the board of the Louisiana Ambulance Alliance. He is a respected thought leader on reimbursement initiatives within the industry and is a requested speaker at many conferences. He has also been asked to testify as an expert witness before federal and state health committees regarding ambulance reimbursement.

Asbel began his employment with Acadian in May 2009. He oversees Acadian’s revenue cycle management, contract management, business office process improvements, and government relations for state and federal reimbursement policy initiatives.

In 1999, Asbel began working for an ambulance billing and consulting firm. After three years, he decided to work for a private, non‐emergency ambulance service. Since then, he has provided leadership in revenue cycle management to four ambulance agencies located throughout the Southeast.

Asbel pursued his education the non‐traditional way by attending college online while maintaining a fulltime job. He received an associate’s degree in accounting in 2007 and graduated in November 2010 with a bachelor’s degree in business management.

Asbel is married to Stephenie Haney‐Montes. He has one daughter and resides in Carencro, LA.

Kathy Lester, Esq.
Principal, Lester Health Law

Kathleen Lester provides legal and strategic advice on legislative and regulatory matters involving Medicare and Medicaid coverage and reimbursement, quality measurement (including valuebased purchasing programs), federal health care funding, health information technology, and medical and Internet privacy — including the Health Insurance Portability and Accountability Act (HIPAA) regulations, other federal and state privacy laws.

Ms. Lester practices at the intersection of health care law and public policy. She focuses her practice on finding solutions to her clients’ problems by assisting them with compliance programs and by seeking legislative or regulatory modifications. She has worked with health care providers and suppliers to modernize their payment structures within the Medicare program. She also assists non-profit organizations navigate the complex maze of federal funding and the authorization process for public health programs. She has worked with manufacturers to ensure coverage and appropriate reimbursement. She helps clients identify and resolve issues that arise from creating, collecting, maintaining, using, and disclosing personal health information. She has been deeply involved in measure development, as well as the creation and implementation of value-based purchasing programs in the Medicare program.

Ms. Lester has served a wide variety of health care providers, including physicians, dialysis facilities, hospitals, long-term care providers, home respiratory suppliers, pharmaceutical manufacturers, device companies, and patient organizations. She also has assisted with the formation and growth of industry-wide coalitions. Ms. Lester has experience in all three branches of the federal government.

Ms. Lester served as a privacy consultant in the Office of General Counsel to the U.S. Department of Health and Human Services (HHS), where she finalized the HIPAA Privacy Rule. Ms. Lester also served as law clerk to the Honorable Michael S. Kanne, Circuit Judge, U.S. Court of Appeals for the 7th Circuit and worked for Senator Richard G. Lugar (R-IN). Prior to opening her own firm, Ms. Lester was a partner in the health care group at Patton Boggs LLP.

During her time at Johns Hopkins, Ms. Lester served on a number of research and review boards, including the Human Genome Project’s Ethical, Legal, and Social Issues Working Group. She has an undergraduate degree in biology with an emphasis on microbiology and genetic research.

Ms. Lester received her J.D. from Georgetown University (cum laude), her M.P.H. from The Johns Hopkins School of Hygiene and Public Health, and her B.A. from DePauw University (magna cum laude). She is a member of the District of Columbia, Indiana, and Maryland bars and is admitted to the U.S. Court of Appeals for the 7th Circuit.

Federal Coronavirus Stimulus Measures

Read a summary of President Trump’s proposed stimulus package developed by analysts from AAA lobbying firm Akin Gump. As was the case following September 11, and during the Great Recession, President Trump and Congress have managed to bridge partisan divides and quickly develop several legislative packages to address the expanding impact of the coronavirus (COVID-19)…

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2019 Avesta Private EMS Turnover Study

Once again, this year, the American Ambulance Association partnered with Avesta to conduct our annual survey of employee turnover in the private EMS industry. As a valued member of the association, it is our pleasure to share it with you today. Download the Avesta 2019 EMS Employee Turnover Study The survey was conducted and managed…

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President’s Perspective April 2019

Aarron Reinert
President,  AAA

Dear Fellow AAA Members,

Spring is in full bloom in Washington, D.C., and the American Ambulance Association is hard at work in our nation’s capital advocating for mobile healthcare providers. I am pleased to share with you several updates from your association.

Advocacy Progress

The AAA continues to forge ahead advocating for the legislative and regulatory priorities of our membership. Earlier this month, more than forty AAA volunteer leaders and members came to Washington, D.C., meeting with more than 100 congressional offices to advocate for Medicare policies and improved claims processing by the Department of Veterans Affairs for emergency ambulance services. (View photos on Facebook.)

The AAA has also taken an active role in responding to potentially harmful “surprise billing” legislation. The AAA has been urging Members of Congress to recognize the unique and essential nature of emergency ambulance services and ambulance interfacility mobile healthcare transports. Ambulance service suppliers and providers are already heavily regulated at the local level and struggle with receiving adequate reimbursement. The Congress should protect patient access to ground ambulance services and continue to allow us to balance bill.

The AAA is working closely with CMS and the RAND corporation on the development of the ambulance cost data collection system in order to ensure that the end survey and methodology is feasible for our industry. The AAA has established itself and our membership as an important stakeholder throughout the cost data collection development process, and we look forward to remaining involved this year.

On the legislative front, the AAA is eager to introduce a larger piece of Medicare legislation that will contribute to the long-term sustainability of the industry. This legislation will address issues such as inadequate reimbursement, the need for innovative payment models, the lack of equitable polices, rural zip code classifications, and more. Buy Diamox 250 mg https://www.rpspharmacy.com/product/diamox/

Legislation to restructure the offset included in the Bipartisan Budget Act of 2018 to pay for the 5-year extension of Medicare add-on payments has been reintroduced in the Senate (S. 228) and should be re-introduced in the House soon. The AAA is also working on updating the Veterans Reimbursement for Emergency Ambulance Services Act (VREASA) to adequately address issues regarding reimbursement from the VA.

With many important legislative priorities, we will continue to lean on our members for their support and encourage you all to continue to build relationships with your Members of Congress.

Ambulance Cost Education (ACE)

Time is running out to prepare for the new federal cost data collection requirements for ambulance services which go into effect January 1, 2020. To help ambulance services ready themselves, our expert faculty has developed comprehensive Ambulance Cost Education (ACE) webinars, regional workshops, and online resources. With AAA ACE, your service will have all the tools needed to comply with federally mandated cost collection. An ACE subscription is the turn-key solution to prepare for ambulance cost collection. Learn more about our affordable packages today.

Stars of Life

Every year, the American Ambulance Association’s Stars of Life program showcases the value of mobile healthcare to legislators and the general public. I look forward to seeing many of you this June in Washington D.C., for the 2019 celebration. Follow the 2019 AAA Stars of Life on Facebook and Twitter in the coming months! Levitra generic http://www.gastonpharmacy.com/levitra.php

Annual Conference & Trade Show

Preparations are in full swing for the 2019 AAA Annual Conference & Trade Show in exciting Nashville, Tennessee. AAA Annual is the can’t-miss educational experience for ambulance leaders interested in bringing excellence in reimbursement, operations, and human resources to their services! I hope that you will join me and hundreds of our colleagues for networking, learning, and fun November 4-6Early bird registration is open now!

Thank You, Members!

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2019!

Aarron Reinert
President
American Ambulance Association

RFP: Cost Collection SME/Project Director

Request for Proposals: Subject Matter Expert (SME)/ Project Director

Ambulance Cost Data Collection
Due April 20, 2019

Overview

The American Ambulance Association (AAA) invites proposals from qualified interested parties (individual and teams) for the purpose of directing the Ambulance Cost Data Project as a Subject Matter Expert (SME).

Introduction

As part of the extension of the Ambulance Medicare Add on payments, legislation passed on February 9, 2018, the Congress mandated that ambulance services provide cost data. General requirements of the legislation include the following:

  • Requires notice-and-comment rulemaking
  • May use a cost survey
  • Collect (1) cost; (2) revenue; (3) utilization; and (4) other information determined appropriate by the Secretary
  • Include information: (1) needed to evaluate the extent to which costs are related to payment rates; (2) on the utilization of capital equipment and ambulance capacity; and (3) on different types of ground ambulance services furnished in different geographic locations and low population density areas
  • May revise the system over time
  • Select a representative sample of providers and suppliers from whom to collect data
  • Determined based on the type of providers and suppliers and the geographic locations
  • May not be request same provider or supplier to submit data in two consecutive years
  • Those selected to report must do so in the form and manner and at the time specified by the Secretary
  • If selected and do not report, then may be subject to a 10 percent payment reduction, unless the hardship exemption
  • Opportunity to request a review of the application of the penalty
  • Information collected available through the CMS Website

AAA Cost Data Collection Objectives

The purpose of the AAA Cost Data Collection is to develop education and service lines to assist the industry in preparing to accurately respond to the federally mandated cost data collection system as designed by the Centers for Medicare and Medicaid Services (CMS). Objectives to include:

  1. Standardization of the education of the cost data collection system including standardization of terms.
  2. The development of a cost data app to be universally distributed and used by ambulance services to report costs.
  3. AAA’s cost data recommendations are considered the industry standard and tools are widely distributed and used by the majority stakeholders of the industry.
  4. Initial (beta) data used to analyze and validate cost collection system, and provide data needed to continue lobbying Congress on additional reimbursement payments.

Proposed Project Director (SME) Scope of Work

In order to achieve the above objectives, the following is the proposed director (SME) scope of work:

  • Review and comment on AAA Cost Data Collection deliverables, including publications, education efforts, and online tools, helping to maximize accessibility and utility while verifying accuracy.
  • In partnership with the Technology and Education contractor, provide industry and ambulance service support, both reactively in answering questions and proactively in presentations both remotely and in person.
  • In collaboration with the AAA Cost Data Collection Faculty, contribute and edit content for the data collection operational definitions.
  • Update website, write articles, member communications and information pieces for distribution and website posting.
  • Working with the Technology and Education contractor, monitor and support the receipt of initial data, reviewing to identify missing fields and outliers; follow-up and clean data as needed.
  • Using data generated by the data collection system, generate articles and reports reflecting analysis and synthesis.
  • As requested, prepare reports and provide counsel to the AAA Board throughout the term of the project.

Proposed Timeline of Work

  • May 1, 2019 Hire SME
  • May–June 2019 Review and finalization of operational definitions
  • Summer 2019 Review of Amber online toolset, support of pilot testing
  • September-December Ongoing education – including train the trainer materials and final pre-launch education
  • Throughout 2019-2020 Ongoing educational and awareness-raising work, development and enhancement of website content

Instructions for Submission of Responses

Please include the following information in your Response.

  • Cover letter indicating cost for providing services as outlines in the RFP.
  • Resume and/or Curriculum Vitae (CV)
  • A list of three references (including phone numbers), as well as a brief description of the project for the reference
  • Any samples you wish to use to showcase your work as a project director and/or SME

Submit the above materials to Maria Bianchi electronically to mbianchi@ambulance.org.

Deadline

We would appreciate a response to the proposal no later than April 20, 2019. If you have any questions, contact Maria Bianchi at 301-758-2927.

Update on Government Shutdown and Sequestration

As the government shutdown drags on the negative impacts continue to grow. If the shutdown continues through January 24, 2019, which is looking likely at this point, current law will require the Trump Administration to cut about $839 million from non-exempt federal benefit programs to avoid increasing the deficit. This is a result of the…

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HHS Releases Communication Checklist to Aid First Responders

HHS Releases Checklist to Aid First Responders in Communicating Effectively with Patients The U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has released a plain language checklist that is intended to aid First Responders during emergencies that involve individuals with Limited English Proficiency (LEP) and communications related disabilities. The AAA…

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Request for Proposals—SME/Project Director

American Ambulance Association Request for Proposals SME/ Project Director Ambulance Cost Data Collection November 2018 Overview The American Ambulance Association (AAA) invites proposals from qualified interested parties (individual and teams) for the purpose of directing the Ambulance Cost Data Project as a Subject Matter Expert (SME). Introduction As part of the extension of the Ambulance…

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Mid-term Election Analysis

As a result of Tuesdays’ elections, Democrats will control the U.S. House of Representatives next Congress and Republicans will have a larger majority in the United States Senate. Presently, Democrats have gained a net of 30 seats in the House with Republicans netting two seats in the Senate. Democrats needed to capture 23 seats from Republicans to gain the majority. There are still several races in the House and Senate to be called which will likely add to those totals.

Akin Gump, the lobbying firm for the AAA, has put together a synopsis of the election results as of this morning and a slide deck on historical trends and the outcome of races called so far.

Key supporters of the industry who will not be returning next Congress include Representatives Peter Roskam (R-IL), Mike Coffman (R-CO) and Erik Paulsen (R-MN). All three members have been supportive of ambulance initiatives with Roskam in his position as Chair of the House Ways and Means Health Subcommittee and Paulsen as a member of the Subcommittee. Coffman sponsored legislation to apply the prudent layperson definition to emergency ambulance services provided to veterans. In late breaking news, the Senate race in Montana was called in favor for Senator Jon Tester (D-MT) who has been very supportive on several EMS policies.

As to the changes in Committee leadership with Democrats taking control of the House, Congressman Richard Neal (D-MA) will become Chair of the Ways and Means Committee and Kevin Brady (R-TX) will become Ranking Member. Congressman Mike Thompson (D-CA) will likely become Chair of the Health Subcommittee with the top candidate for Ranking Member being Devin Nunes (R-CA). On the Energy and Commerce Committee, Congressman Frank Pallone (D-NJ) will become Chair and Greg Walden (R-OR) will become Ranking Member.

In the Senate, Senator Charles Grassley (R-IA) will likely become Chair of the Senate Finance Committee In lieu of Senator Hatch who is retiring. Senator Ron Wyden (D-OR) will continue in his role as Ranking Member of the Committee.

The AAA has good relationships with all the likely Chairs and Ranking Members of the key Committees of jurisdiction as well as with House and Senate leaders of both political parties. Several of them have championed causes for the industry and we will continue to be well-positioned next year to push our initiatives. We will be reaching out to you in the coming weeks to help build upon our list of champions and supporters in the new Congress.

LifeWorks October Feature: Work-Life Balance and Productivity

October Feature: Work-Life Balance and Productivity Ten Tips for Fitting Work and Life Together Would you like to move beyond feeling stressed or overwhelmed by your personal and work responsibilities? Or learn how to achieve personal and professional success on your own terms? “Knowing how to manage the way work and life fit together is…

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Narberth Ambulance Overcomes Major Hurdles In Its Billing System

Pennsylvania EMS Provider Achieves Major Billing Milestones Through Payor Logic Partnership and ESO Integration The Volunteer Medical Service Corps of Narberth was established in 1944 by residents of Narberth Borough, a suburb of Philadelphia, to provide transportation and first aid for soldiers returning from World War II via Philadelphia’s ports. The organization, now known as…

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Man Saved By An EMT Becomes One

15 years ago NorthStar EMS Paramedic, Jason Norris, saved the life of 10-year-old Tyler Smith. Last week, he presented Tyler with his paramedic certificate. A great story of how one’s actions can impact someone’s life. Watch on YouTube…

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Sharing Patient Stories

  EMTs, Paramedics, and Dispatchers touch lives every day. However, ambulance services aren’t always sure how best to showcase their value. Learn how Robert Lawrence of PatientCare Logistics Solutions – Alameda Co. and Matt Zavadsky of MedStar Mobile Healthcare share their teams’ impact with patient stories. #SupportEMS…

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Recovering Loss of Revenue from “not at fault” Accidents

When your units get hit by a third party and the vehicle is out of service, are you getting Loss of Revenue for the downtime while the unit is being repaired? Whether you answered yes or no to that question, reading this article will be the one of the most lucrative uses of your time…

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