CMS SNF Edits Go Into Effect – April 1, 2019

CMS Set to Implement New Common Working File Edits to Identify Ambulance Services Provided in Connection with Outpatient Hospital Services that should be bundled to the SNF under Consolidated Billing On November 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 2176 (Change Request 10955), which would establish a new series of Common Working File (CWF) edits intended to identify ambulance transports furnished in connection with outpatient hospital services that are properly bundled to the skilled nursing facility under the SNF Consolidated Billing regime. These new edits are set to go into effect on April 1, 2019.  Why these edits are necessary? In 2017, the HHS Office of the Inspector General conducted an investigation of ground ambulance claims that were furnished to Medicare beneficiaries during the first 100 days of a skilled nursing home (SNF) stay. Under the SNF Consolidated Billing regime, SNFs are paid a per diem, case-mix-adjusted amount that is intended to cover all costs incurred on behalf of their residents.  Federal regulations further provide that, with limited exceptions, the SNF’s per diem payment includes medically necessary ambulance transportation provided during the beneficiary’s Part A stay. The OIG’s report was issued in February 2019. The OIG...

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2017 National and State-Specific Medicare Data

The American Ambulance Association is pleased to announce the publication of its 2017 Medicare Payment Data Report. This report is based on the Physician/Supplier Procedure Summary Master File. This report contains information on all Part B and DME claims processed through the Medicare Common Working File and stored in the National Claims History Repository. The report contains an overview of total Medicare spending nationwide in CY 2017, and then a separate breakdown of Medicare spending in each of the 50 states, the District of Columbia, and the various other U.S. Territories. For each jurisdiction, the report contains two charts: the first reflects data for all ambulance services, while the second is limited solely to dialysis transports. Each chart lists total spending by procedure code (i.e., base rates and mileage). For comparison purposes, information is also provided on Medicare spending in CY 2016. Questions? Contact Brian Werfel at  ...

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OIG Report on Overpayments For Non-Emergency Transports

OIG Report – Overpayments For Non-Emergency Ambulance Transports To Non-Covered Destinations The Office of the Inspector General released its report “Medicare Improperly Paid Providers for Non Emergency Ambulance Transports to Destinations Not Covered by Medicare“. In sum, the OIG reviewed claims that Medicare paid for 2014 – 2016 non-emergency ambulance transports. The review focused on transports to non-covered destinations. OIG found that $8,633,940 was paid by Medicare for non-emergency ambulance transports under codes A0425 (ground mileage), A0426 (ALS non-emergency) and A0428 (BLS non-emergency) during this period of time. The review was based solely on the claims and not based on a medical review or interviews of providers. The claims that should not have been paid were to the following destinations: 59% – to diagnostic or therapeutic sites other than a hospital or physician’s office, that did not originate at a SNF. 31% – to a residence or assisted living facility (and not meeting the origin/destination requirement).  6% – to the scene of an acute event.  4% – to a destination code not used for ambulance claims or where no destination modifier was used. <1% – to a physician’s office. OIG recommended (and CMS agreed) that CMS: Notify the Medicare Administrative...

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OSHA: Transportation-Related Incidents Top Workplace Fatality List

Yesterday, OSHA issued a statement regarding fatal occupational injuries in 2016. Transportation-related incidents were the most frequent cause of workplace fatality in the United States last year. While the biggest part of our services is providing highest-quality medical care to people in need, the safe transportation of patients and crews plays a significant role. As an industry, we should do everything we can to ensure that every provider goes home at the end of their shift....

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HR Wrap-Up: A Look Back at 2016

As we wind up 2016 I thought it would be a good idea to review the year’s human resource and legal developments to ensure that our members are compliant and prepared for what faces them in 2017.  We knew that this was going to be an interesting year as we experienced the most unusual Presidential Election in our history.  It overshadowed everything else that occurred in 2016.  As the Obama administration comes to its final days, employers and ambulance providers saw some of the most sweeping regulatory changes. Fair Labor Standards Act (FLSA) The biggest change facing employers in 2016 was the Fair Labor Standards Act (FLSA) overtime changes.  The Department of Labor (DOL) issued updated regulations which were to become effective December 1, 2016, raising the minimum salary thresholds for the so called “white collar” exemptions.  Under the new regulations, the minimum salary would increase from $455 to $970 per week.  For those employees earning under the new amount, employers would need to decide if they are going to raise the salary level or pay the employee overtime for hours worked over 40 in one week.  The changes have not gone into effect yet as a 5th Circuit Judge...

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 Ambulance Payment Reform Whiteboard Video

The American Ambulance Association needs your help to build the future of EMS—an innovative industry compensated fairly and recognized appropriately for the critical healthcare it provides. Learn more in the video below, then visit our Payment Reform page to get involved! Ambulance services across the country are struggling to survive in the face of falling reimbursement, short-sighted regulations, and rising costs. EMS providers of all sizes must share critical cost data, meet with legislators, and speak with one voice as we work to surmount these obstacles and position ambulance services for success today and for many years to come.

Trump Healthcare Transition Analysis

President-elect Donald Trump is naming more members of his transition team as he prepares to form his cabinet and key White House position.  In the healthcare arena Andrew Bremberg will take the lead on transition issues related to the Department of Health and Human Services (HHS). Bremberg, who has been working on the Trump transition team since the Republican National Convention in July, worked at HHS for nearly eight years under the George W. Bush Administration. Bremberg later advised Senate Majority Leader Mitch McConnell on health policy and served on Mitt Romney’s transition team in 2012. Most recently, he worked on Scott Walker’s health care team during the Wisconsin governor’s presidential campaign.  He is viewed as a traditional inside professional with a strong working knowledge of the health care system. The Trump transition team is currently focused on cabinet-level picks. Candidates to become HHS Secretary in the new Administration reportedly include:  Dr. Ben Carson, a retired neurosurgeon and former GOP presidential candidate; former House Speaker Newt Gingrich; former Louisiana Gov. Bobby Jindal; Rich Bagger (we previously worked with him when he was at Pfizer and we represented the company), executive director of the Trump Transition team and a pharmaceutical executive;...

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CMS List of Medically Unlikely Edits for Ambulance Services

On October 1, 2016, the Centers for Medicare and Medicaid Services (CMS) updated its list of Medically Unlikely Edits (MUEs). The MEU program is designed to reduce the paid claims error rate for Part B claims. The program operates by estimating the maximum number of units of service that a provider/supplier would report under most circumstances for a single beneficiary on a single date of service. A claim that submits units of service in excess of this threshold will typically be denied by the Medicare Administrative Contractor. For additional information on the CMS Medically Unlikely Edit Program, click here. Effective October 1, 2016, claims for ambulance services will be subject to the following MUE edits: HCPCS Code MUE Threshold A0425 (Ground Ambulance Mileage) 250 A0426 (Ground Ambulance, ALS Non-Emergency) 2 A0427 (Ground Ambulance, ALS Emergency) 2 A0428 (Ground Ambulance, BLS Non-Emergency) 4 A0429 (Ground Ambulance, BLS Emergency) 2 A0430 (Air Ambulance, Fixed Wing) 1 A0431 (Air Ambulance, Helicopter) 1 A0432 (Ground Ambulance, Paramedic Intercept) 1 A0433 (Ground Ambulance, ALS-2) 1 A0434 (Ground Ambulance, Specialty Care Transport) 2 A0435 (Air Ambulance, Fixed Wing Mileage) 999 A0436 (Air Ambulance, Helicopter Mileage) 300  ...

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President Postma’s Capital Campaign

At the 2016 AAA Annual Conference & Trade Show, new president Mark Postma announced a visionary capital campaign to build our association’s reserves to $1 million. We invite all members to give as they are able to build a rainy day fund capable of weathering any storm. Thank you in advance for your support and participation. Funds contributed to the Capital Campaign can only be used by the association following a board vote. Pledge Now

2016 AMBY Innovation in EMS: Tri-State Ambulance, Patient Transport Project

Tri-State Ambulance Awarded a 2016 AMBY for Innovation in EMS Ambulance services which provide 911 coverage frequently have patients who request service but ultimately fail to accept transportation to a hospital for further care. Depending on the service area, non-transports can be 30% or more of all requests for service. These ambulance responses can range from falls or diabetic issues, to motor vehicle crashes and anything in between. It is known that transporting a patient to an emergency department is not always the most appropriate choice for their medical care. Often, a visit or a conversation with their primary care or specialty provider may be a better option. Due to HIPAA regulations and continuity of care rules, the patient response information, when they are not transported, does not proceed further than a typical quality assurance or billing department review. This ultimately leaves the patient’s primary care provider or other specialty care provider completely unaware that their patient was cared for by another medical professional in an urgent setting. Upon investigation we found that the general public was unaware that their information from the contact with an ambulance service was not being sent to their current providers. In an electronic world, the general assumption (more…)

2016 AMBY Best Use of Technology: Trinity EMS & Firstwatch, Opioid Epidemic Project

Trinity EMS & FirstWatch Opioid Epidemic Project Awarded a 2016 AMBY for Best Use of Technology Trinity EMS & FirstWatch | Massachusetts Massachusetts has seen a massive increase in opiate overdoses and deaths. In 2013 there were 918 opiate related deaths in Massachusetts. Massachusetts had 1531 deaths in the first six months of 2016. Many of the communities Trinity EMS serves are on the front lines of this issue. Their EMT’s and paramedics are helping to revive patients every day from an opiate overdose. Understanding the scope of an issue is a critical first step to solving an issue. They started using their PCR data to help frame the issue for their communities. They began tracking the demographics such as age and gender of the patients, time of day and day of the week, and location within the communities. They also monitor the volume to identify spikes in volume in individual communities and system wide. Trinity reported data monthly, one month behind to the health department, public safety partners, methadone clinics, hospitals and city governments. This data was well received. Other services contacted them for help in developing their tracking and reporting. They added FirstWatch to their program to speed up the notifications. (more…)

2016 AMBY Best Quality Improvement Program: Gold Cross Ambulance, Documentation Program

Gold Cross Ambulance’s Documentation Project Project Awarded a 2016 AMBY for Best Quality Improvement Program Gold Cross Ambulance | Utah The documentation review process at Gold Cross Ambulance had not changed much since the day of paper trip tickets. Retrospective documentation feedback was being given to crews, but they were not fully utilizing the capabilities of their technology to analyze the feedback and make significant improvements. Gold Cross Ambulance hypothesized that improved documentation goals would lead to better patient care and increased reimbursements. They knew they needed to make improvements in the review process and to better utilize the technology that was already in place. In addition to the documentation goals, they identified the opportunity to work some small, but significant, clinical improvements into a documentation project. One initial focus of clinical improvement was making sure the field crews were obtaining at least two sets of vital signs on every patient, and properly documenting these vital signs in the electronic patient care report (ePCR). Of all the performance indicators we measure, trending of vital signs touches every patient contacted. Educators from Utah EMS for Children shared research citing “inadequate recognition of and response to hypotension and hypoxia was associated with higher odds of disability and death” (Hewes (more…)

2016 AMBY Best Community Impact Program: Medic Ambulance, Reduced Readmissions Project

Medic Ambulance Reduced Readmissions Project Awarded a 2016 AMBY for Best Community Impact Program Medic Ambulance | California Medic Ambulance Service is the exclusive ALS service provider in Solano County, a HRSA-designated medically underserved area with a physician-provider to population ratio of 81.1 per 100,000. In 2014 Medic Ambulance became aware of an opportunity to participate in a Community Paramedicine Pilot initiated through California Ste EMSA. After collaborating with LEMSA and the community hospitals, Medic Ambulance unanimously concluded that the 23% average readmission rates for each CHF and COPD patients was taking a crippling toll on the hospitals’ reimbursement and increasing Emergency Department wait times. Starting in January of 2015, Medic Ambulance Service enrolled six paramedics into approximately 300 hours of additional training focused on the biopsychosocial needs of patients with CHF or COPD. The education has continued through monthly case reviews and peer-to-peer lessons-learned where the entire team brainstorms innovative solutions to the patients’ challenges. From the beginning, Medic Ambulance Service was poised on creating a sustainable model that would persevere past the period of being a pilot or grant funding. They made this goal of preservation well-known to all stakeholders, and after quickly proving the value through low readmission rates they had established (more…)

2016 AMBY Best Public Relations Campaign: EMSA, CPR Education Program

EMSA CPR Education Program Awarded a 2016 AMBY for Best Public Relations Campaign Emergency Medical Services Authority (EMSA) | Tulsa, Oklahoma EMSA, the Emergency Medical Services Authority, is Oklahoma’s largest provider of pre-hospital emergency medical care. We provide ambulance service to more than 1.1 million residents in central and northeast Oklahoma. EMSA was established in Tulsa in 1977 and later expanded to include Bixby, Jenks and Sand Springs. EMSA began providing service to Oklahoma City in 1990. EMSA is the ambulance provider in 16 cities across the state. As a public trust authority of the City of Tulsa and City of Oklahoma City governments, EMSA is charged with ensuring the highest quality of emergency medical service at the best possible price. There are several entities that work together in the EMSA system, including the Cities of Oklahoma City and Tulsa, the medical director, and the contracted ambulance provider. EMSA oversees all business aspects including ambulances and other capital equipment, maintaining patient records, billing and more. The medical director conducts routine audits and testing of all medics practicing in the system, writes seamless protocols to ensure the continuity of care between first responders and transport medics, researches new treatment modalities and evaluates complaints. EMSA (more…)

2016 AMBY Best Community Impact Program: AMR, River Rescue Program

American Medical Response River Rescue Program Awarded a 2016 AMBY for Best Community Impact Program AMR | Oregon The Oregon River Safety Program (aka AMR River Rescue Program) is provided by American Medical Response (AMR) as a community service for two communities it serves in Oregon. The program is the only one of its kind exclusively operated by a private EMS provider, supported by strong community partnerships, and was developed after a series of thirteen drowning deaths over five years in the 1990s at two popular river parks. Ten years earlier, AMR developed its Reach and Treat (RAT) Wilderness Medicine Program to provide medical care for people ill or injured on Mount Hood and the surrounding national forest. Since Swift Water Rescue was part of the existing Reach and Treat Teams training and competency, AMR worked with the Troutdale City Council and a group of dedicated civic leaders to launch the River Rescue Program in July, 1999. For the remainder of the summer, AMR used its RAT Team members as Swift Water Rescue Specialists to staff the new River Rescue program. The program was developed to meet the certification standards of the United States Lifesaving Association (USLA) for open water lifeguarding, and is staffed by (more…)

2016 AMBY Best Clinical Outcome: Advanced Medical Transport, Race to the Top Program

Advanced Medical Transport’s Race to the Top Program Awarded the 2016 AMBY for Best Clinical Outcome Advanced Medical Transport (AMT) | Peoria, IL Advanced Medical Transport (AMT) developed the Race to the Top Program to provide the communities they serve with some of the top cardiac resuscitation rates in the nation. “By concentrating on eight highly-interdependent elements of a world-class emergency cardiac care and response system, we soldier more forces together and win more battles in the war on sudden cardiac arrest,” said AMT’s Josh Bradshaw. Even before implementing Race to the Top, AMT’s cardiac arrest resuscitation rates were three times the national average.  However, the leadership team felt that they could push the rates higher through a multifaceted outreach program. The project began in in late 2014, with eight specific, measurable, and actionable objectives: Immediate recognition of sudden cardiac arrest; 911 activation, “First-Care” hands-only CPR, GPS to the rescue (PulsePoint); Access to and utilization of AEDs; Pit crew resuscitation by EMS providers; Deployment of Advanced Practice Paramedics; Advanced biomedical tools; Immediate provider feedback; and Community and caregiver recognition. AMT began the program with a Return of Spontaneous Circulation rate of 27%, and have now reached 45%, well on the way to their near-60% goal. The (more…)

Akin Gump Political Report 2016

Akin Gump Strauss Hauer & Feld, LLP, advocates for the American Ambulance Association, have empowered us to share with members their coveted pre-election political report. Download your copy today, covering hot topic election issues including healthcare, transportation, and more. (Please note that the report is for members only.)

2016 Board of Director Candidates

Election Timeline | Board Candidates | Ethics Committee Candidates The 2016 AAA Election is going paperless and this year’s election will be held entirely online. Primary contacts of Active Single State and Multi-State Members are permitted by AAA’s bylaws to vote in board elections. Election Timeline 9/30 | Voting Opens Ballots will be delivered to AAA Active Member primary contacts via email from 10/28 | Voting Closes 11/8 | Election results announced at the 2016 AAA Annual Conference & Tradeshow. Slate of Candidates Thank you and best of luck to this year’s slate of talented and seasoned board candidates. Ethics Committee Candidates Thank you to the following candidates for the AAA Ethics Committee. Voters may select up to three. Hanan Cohen – Empress EMS Brent Dierking – NorthStar EMS, Inc. John Iazzetta – Alert Ambulance Service, Inc. Jay Jimenez – Allegiance Mobile Health Robert Sims – Lifeguard Ambulance Service Steven Vincent – Gold Cross EMS Rebecca Williamson – Muskogee County EMS Questions? Please contact for assistance.