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 bwerfel@aol.com.  ...

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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