Tag: 2018

2018 National and State-Specific Medicare Data

The American Ambulance Association is pleased to announce the publication of its 2018 Medicare Payment Data Report. This report is based on the “Early Edition” of the 2018 Part B National Summary Data File (previously known as the Bess Report). The report consists of an overview of total Medicare spending nationwide, 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, with the second limited to dialysis transports. Each chart is further broken down by HCPCS code. The charts provide information on the total number of allows services and the total Medicare payments for CYs 2017 and 2018. Percentage changes will allow members to view payment trends over the past year.

2018 National & State-Specific Medicare Data

Questions? Contact Brian Werfel at bwerfel@aol.com.

 

CMS Announces 2019 Ambulance Inflation Factor

On November 30, 2018, CMS issued Transmittal 4172 (Change Request 11031), which announced the Medicare Ambulance Inflation Factor (AIF) for calendar year 2019.

The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year. Starting in calendar year 2011, the change in the CPI-U is now reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi-factor productivity index (MFP). The MFP reduction may result in a negative AIF for any calendar year. The resulting AIF is then added to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule.

For the 12-month period ending in June 2018, the federal Bureau of Labor Statistics (BLS) has calculated that the CPI-U has increased 2.9%. CMS further indicated that the CY 2019 MFP will be 0.6%. Accordingly, CMS indicated that the Ambulance Inflation Factor for calendar year 2019 will be 2.3%.

Mid-Term Election Analysis Webinar

Join AAA Government Affairs Committee Chair, Jamie Pafford-Gresham, AAA SVP of Government Affairs, Tristan North, AAA Senior Manager of Federal Affairs, Ruth Hazdovac, and Manager of State & Federal Government Affairs, Aidan Camas, as they provide a brief re-cap of the recent mid-term elections. This pre-recorded webinar provides an update on federal and state election results, and how they may impact our industry. We review possible leadership changes in the House & Senate as well as on key committees of jurisdiction over ambulance related legislation. The webinar also provides a brief look ahead into AAA legislative priorities for 2019. If you have any questions about material covered on the presentation, please email Aidan Camas at acamas@ambulance.org.

►Watch the video on Youtube here

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.

CMS Launches Outreach Effort to Ambulance Providers & Suppliers

As part of the Bipartisan Budget Act of 2018 (BBA 2018), the Congress instructed CMS to develop a cost collection system to collect cost and revenue data related to the provision of ambulance services. Ambulance services are defined by federal law to include all levels of emergency and non-emergency services. 

CMS is in the first phase of this process. The Congress instructed the Agency to engage with stakeholders before specifying through notice and comment rulemaking the data collection system. By law, CMS is required to specify the final system by December 31, 2019. CMS must also identify the first group of providers and suppliers selected for the first representative sample by that date as well. It appears that the goal is to have the contractor develop a proposal before the 2019 rulemaking cycle which will begin next summer.

To engage with the stakeholders, CMS, through its contractor the RAND Corporation, is reaching out providers and suppliers to learn more about the costs and revenues associated with providing ambulance services.

During the American Ambulance Association’s annual meeting earlier this month, CMS through the RAND Corporation, convened a focus group where they selected several AAA members who were able to talk directly with the contractor. The discussion centered around characteristics of ambulance services that matter for determining costs. The group also talked about how data is currently captured at the state and local levels, as well as how data is tracked within ambulance services. There was also a lot of discussion about the importance of standardizing data elements and not relying upon different state or local definitions, which could confound the data and make it impossible to compare costs across states.

As we have reported previously, it is critically important that the data collected through this process is standardized and reflects the actual cost of providing ambulance services. It is important to make sure that the data is useable not only for supporting the ambulance add-ons after they next expire in 2023, but also to help implement broader reforms and innovative payment models.

CMS is now reaching out to others in the industry. If you receive an email or a phone call from RAND Corporation, please respond. 

If you have questions about, or would like assistance with regard to, this project, please contact Tristan North at tnorth@ambulance.org.

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 a modern skill set we all need to succeed,” says Cali Williams Yost, an internationally recognized flexible workplace strategist and author of the books Tweak It: Make What Matters to You Happen Every Day and Work+Life: Finding the Fit That’s Right for You. Here are Yost’s 10 strategies:

  1. Remember that work-life fit is unique for each of us. “Simply put, there is no work-life balance or perfect 5050 split between your work and your personal life,” Yost says. “If you do happen to hit a balance, you can’t maintain it because your realities are always changing, personally and professionally.” There’s also no “right way” to achieve a good work-life fit. Your goal is to find your unique, ever-changing fit, the way your work and personal realities fit together day-to-day and at major life transitions. Don’t compare yourself to others. Find the fit that’s right for you.
    It’s also important to keep in mind that during major life changes — like becoming a parent, caring for an aging relative, relocating with a partner, going back to school, or easing your way into retirement — you may find yourself rethinking how you define success related to money, prestige, advancement, or caregiving. Throughout life, you may need to align and adjust your work and personal realities so they match with your vision and goals for the future.
  2. Harness the power of small actions or “tweaks”. Even small actions can have positive and lasting effects. When you’re feeling overloaded, for example, commit to taking two or three small but meaningful steps toward a better work-life fit. Plan a long weekend away with friends. Clean out your hall closet. Take an online class to learn a new skill. Then do it again and again. Small actions can have a big impact on your sense of well-being and control. To get started, check out more than 200 small, doable get-started actions suggested by 50 work, career, and personal life experts in Yost’s book Tweak It.
  3. Create a combined calendar and priority list. On top of a busy job and home life, how will you fit everything else into your schedule? There’s exercise, eating well, vacation, sleep, career development, time with family and friends, caregiving responsibilities, and just general life maintenance. You can’t do it all. But you can be more intentional and deliberate about how you spend your time.
    First, pull together all your work and personal to-dos and priorities into one combined calendar and list. This will help you determine how you want to prioritize the tweaks — small, meaningful work, career, and personal actions and priorities — to add to your work-life fit. For example, tweaks might include planning all meals and shopping for your groceries on Sunday or getting to exercise class every Tuesday and Saturday. Or they might include researching a vacation one afternoon, going to the movies with your sister, or attending a networking event. Building actions into your schedule makes it far more likely they’ll happen. And you’ll feel better as a result.
  4. Take care of yourself in small ways. Small changes can make a big difference in how you feel. Manage stress during the day by closing your eyes for 15 seconds and taking a few deep breaths. Try to eat more healthfully by adding a vegetable to two of your meals during the day. Turn off the television and your electronic devices an hour before you go to bed to help you get the rest you need.
  5. Preview a skill online before you pay to take a class. In a rapidly changing world, all of us need to keep updating our skills to meet new work and other realities. But going back to school can be expensive and time consuming. Before you invest a substantial amount of money in a class, try to preview a skill online. Watch or listen to any of the hundreds of thousands of videos or podcasts on an infinite number of topics that you can preview by downloading or streaming them. Watch them while you’re commuting, or listen to them while you walk. If you want or need more help than the video or podcast provides, invest in a class
  6. Collect ideas for vacations — then take one. Taking a break to reenergize is more important than ever in our on-the-go world. And many people don’t take vacations just because they don’t know where to go. It takes some research to find a destination that you can afford, and some of us don’t do this until it’s too late. To get inspired, keep a jar or small box where you can store vacation ideas. Every time you hear a friend or relative talk about a wonderful vacation, write down what appeals to you about it and put it there. When you read an article about a place that sounds interesting, put that in the box or jar, too. Once a year, pick a destination from all of the vacation ideas you’ve accumulated.
  7. Get things done while you’re enjoying family and friends. Cook dinner with your kids. When you prepare a meal together, you’re also spending time together. Take a walk with your close friend before work or a tae kwon do class with your partner on the weekend. You’ll be exercising while spending quality time together. At holiday times, plan a cookie exchange and donate some of the cookies to a women’s shelter.
  8. Have 10 technology-free minutes each day with your children. Give the kids time when you aren’t distracted by electronic gadgets. Sit on the floor and do a puzzle. Ask teenagers how their day went, and just listen. Check your email only at certain times of the day, so you aren’t always on it when children need you. When you’re on the phone, turn around and face away from your computer so you aren’t distracted by email. Looking away from the screen will force you to pay attention to the person you’re talking with.
  9. Plan for future caregiving responsibilities. Get a head start if you’re taking care of a grandparent or may be caring for a parent or other relative in the future. Sit down with the adults in your life who may require care. Try to clarify what they want, understand their financial resources, and come up with a plan for meeting their needs and wishes. Try to include in the meeting any family and friends who form a broader network of care, so you don’t have to do it all on your own. Don’t wait for a crisis.
  10. Keep on top of everyday maintenance. Clean as you go, so the work doesn’t pile up. Put a load of laundry in the washing machine in the morning before you leave for work, and put it in the dryer when you get home. Keep a small bucket of cleaning supplies in the bathroom, and wipe down the shower, mirror, and toilet every morning. Set a timer for 10 minutes each weekend and assign each member of your family a task — vacuuming, dusting, straightening up. Check the owner’s manual of your car for the recommended maintenance schedule and write it on your calendar.

For more tips like these, listen to the recording Fitting Work and Life Together on the LifeWorks platform.

Free, confidential counseling for employees of AAA member organizations.

LifeWorks is your employee assistance program (EAP) and well-being resource. We’re here for you any time, 24/7, 365 days a year, with expert advice, resources, referrals to counseling, and connections to specialists including substance abuse and critical incident stress management professionals. If you could benefit from professional help to proactively address a personal or work-related concern, you can turn to LifeWorks.

  • Counseling is available at no cost to you. (Up to three sessions per issue.)
  • To meet individual needs and preferences, counseling is available face-to-face AND live by video.
  • All our counselors are experienced therapists with a minimum Master’s degree in psychology, social work, educational counseling, or other social services field.

Call LifeWorks, toll-free, 24/7, at 800-929-0068.
Visit us online at login.lifeworks.com or by
mobile app (username: theaaa; password: lifeworks)

 

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 Narberth Ambulance, has expanded over the past 70 years from a small station with two ambulances to a full-fledged EMS service that makes nearly 10,000 trips annually, employs 33 full-time staff, 44 part time employees, and 80 volunteers. Narberth covers four Philadelphia area communities with two stations, seven ambulances, two responder vehicles and one mass casualty/rehab bus.

While Narberth Ambulance has seen tremendous growth and success throughout its history, recent times have brought new challenges. Changing technology in the healthcare industry paired with declining reimbursement over the past several years left Narberth, like many other EMS services, facing issues with its billing system and claims processing. These complications made claims longer to work and payment harder to collect. At the height of this problem, Narberth’s billing team needed from five to ten business days to process a claim.

The Issue at Hand

According to Meg Nelson, billing lead for Narberth, “The first barrier encountered by our billing staff was simply trying to obtain correct demographic and insurance information for our patients.” Narberth faced ongoing issues in efforts to receive face sheets and up-to-date information from local hospitals. Despite access to EHRs at hospitals, repeated follow-up calls became a necessity, hampering the productivity of those involved on both the hospital and EMS sides.

John Roussis, executive director of Narberth Ambulance, also shared his insight on the issues. “Because our data was often incorrect, we experienced a high volume of return mail,” he said. “The administrative burden was a huge challenge with hundreds of steps to hunt down correct addresses, multiple piles of return mail, and extra postage to resend invoices.” Furthermore, decreases in coverage from commercial and government payors made it increasingly difficult to obtain correct, valid and billable insurance information to process claims and collect payment.  Narberth clearly needed to make monumental changes to its claims processing, insurance discovery and payor reimbursement practices to avoid further harm to the organization’s financial stability.

EMS Billing Interoperability Cuts Manual Intervention by 80%

In 2017, Narberth implemented new revenue cycle technology to increase efficiency in each of the previously mentioned areas. The application was seamlessly integrated with ESO, Narberth’s established billing system, to reduce return mail, boost staff productivity and hasten reimbursement.  Here’s how interoperability between the two systems works:

  • The Narberth crew enters information into ESO’s patient care record after a trip completion.
  • Once entered, the data is automatically uploaded in the vendor’s billing module.
  • A part-time staff member verifies the chart for accurate data, enters charges and preps the case for billing.
  • Within ESO, the new technology application from Payor Logic sends an immediate query to find any missing demographics, insurance information or other pertinent details in real time, and populate the ESO billing software with correct, billable information.

With this system in place, Narberth’s billing staff conduct their manual process only if no information is available—a mere 20 percent of the time. Narberth Ambulance has effectively dropped its time to work a claim from an estimated seven days down to only seven minutes.

“We’ve relieved billing burdens and effectively reduced time to process claims by 66 percent,” said Roussis. “We are now performing only one third of the paperwork, calls and claims-related tasks that we handled before. Our team calls the integrated ESO and Payor Logic solution the magic button for EMS billing.”

Payability and Deductibles Next Target

With its billing system now automated and integrated, Narberth’s claims processing efficiency is better than ever—time waste is down and dollars have become far easier to collect. However, Roussis doesn’t want to stop there.

Roussis intends to continue tackling inefficiency. He plans to use Payor Logic to help address communication issues with commercial payors, analyze payment likelihood for self-pay accounts, and improve the organization’s deductible management.

The issues Narberth Ambulance faced are bound to become more common in the EMS world as the healthcare industry becomes more reliant on increasingly complex technology. The most important takeaway in the face of change is that integrated EMS technology solutions are out there to keep billing struggles from distracting providers from their top priority—saving lives.

2018 AAA Board of Directors Election Results

The winners of the 2018 AAA Board of Directors election are listed below. Please join us in thanking all candidates for their service to the American Ambulance Association.

President-Elect

President-Elect (2020)

Shawn Baird
Co-Owner
Woodburn Ambulance Service, Inc.
Woodburn, OR

 

Treasurer

Treasurer (2020)

Julie Rose
CEO/Executive Director; Board Secretary/Treasurer
Community Care Ambulance
Ashtabula, OH

 

Secretary

Secretary (2020)

Randy Strozyk
Executive Vice President
American Medical Response
Seattle, WA

 

Region I

Director (2020)

Mike Addario
Vice President of Operations – New York
American Medical Response
Syracuse, NY


 

Alternate Director

Reginald Allen
Chief Executive Officer
CHS Mobile Integrated Health Care
Rochester, NY

 

Region II

Director (2020)

Chuck Kearns
Chief Executive Officer
Mercy Ambulance Service d/b/a Chatham EMS
Savannah, GA

 


Alternate Director

Terence Ramotar
Regional Director
American Medical Response
Tampa, FL

 

Region III

Director (2020)godden-kim

Kimberly Godden
Vice President, Legal and Corporate Compliance
Superior Air-Ground Ambulance Service, Inc.
Elmhurst, IL

 


 

Alternate Director

Tom Tornstrom
Executive Director
Gundersen Tri-State Ambulance
La Crosse, WI

 

Region IV

Director (2020)lehman-angie

Angela Lehman
Chief Revenue Officer
Emergency Medical Services Authority
Tulsa, OK

 


 

Alternate Director

Doug Hooten
Chief Executive Officer
MedStar Mobile Healthcare
Fort Worth, TX

 

Region V

Director (2020)

Paul Pedersen
Managing Partner
Arizona Ambulance Transport
Sierra Vista, AZ


Alternate Director 

Rob Lawrence
Chief Operating Officer
Paramedics Plus
San Leandro, CA

 

2018 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2018 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize AAA members. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on September 7, 2018. Please join us in congratulating our 2018 winners!

Clinical Outcome Program

Medic Ambulance Service, Inc. | Vallejo, CA

Community Impact Program

NorthStar EMS, Inc. | Tuscaloosa, AL

Employee Programs

Hall Ambulance Service, Inc. | Bakersfield, CA

Innovation in EMS

Priority Ambulance | Knoxville, TN

Mercy Ambulance Service, Inc. | Savannah, GA

Public Relations Campaign

MEDIC EMS Agency | Charlotte, NC

Hall Ambulance Service, Inc. | Bakersfield, CA

Quality Improvement Program

Sunstar Paramedics | Largo, FL

Patient and Employee Safety Program

Priority Ambulance | Knoxville, TN

Once again, join us in celebrating the 2018 winners! Learn more about the AMBYs.

 

2018 AAA Award Winners Announced

The American Ambulance Association is proud to announce this year’s award winners. Awards will be presented at the AAA Annual Conference & Trade Show Membership Meeting on Friday, September 7, 2018. Please join us in congratulating this year’s winners!

J. Walter Schaeffer Award

Dale Berry
The J. Walter Schaeffer Award is given annually to an individual whose work in EMS has contributed positively to the advancement of the industry as a whole. Dale has achieved this through his many years of commitment and service to the ambulance industry.

Robert L. Forbuss Lifetime Achievement Award

The Honorable Harvey Hall
The Robert L. Forbuss Lifetime Achievement Award is named in honor of the first Executive Director of the American Ambulance Association. It recognizes a volunteer leader who has made a significant long-term impact on the association. your decades of service, commitment, and dedication to the private ambulance industry, the AAA, and its members. The Honorable Harvey Hall has achieved this through his decades of service and dedication to the private ambulance industry, the AAA, and its members.

President’s Award

Jonathan Washko
These awards are bestowed by the President to volunteer leaders who have shown commitment to the advancement of the AAA, above and beyond the call of duty. This year, Jonathan Washko is being honored for being an outstanding volunteer who has worked tirelessly to advance high performance EMS.

2018 Affiliates of the Year

JEMS
The American Ambulance Association (AAA) is proud to award JEMS Magazine with the 2018 Affiliate of the Year Award. JEMS has achieved this honor through their support of AAA’s programs and services as our media partner.

Solutions Group
The American Ambulance Association (AAA) is proud to award Solutions Group with the 2018 Affiliate of the Year Award. Solutions Group has achieved this honor through their support of AAA’s educational programs and events.

EMS Partnership of the Year

The American Hospital Association
The EMS Partnership of the Year Award is given to an organization or individual whose collaboration with the AAA enhances educational programs, legislative priorities, and/or member benefits. The American Hospital Association has achieved this honor through their support of our 2018 legislative priority.

Distinguished Service Award

Amanda Riordan
AAA Vice President of Member Services Amanda Riordan is receiving a 2018 Distinguished Service Award in recognition of her dedication and commitment to advancing AAA’s programs and services.

Join us once again in congratulating the 2018 winners! Learn more about the Annual Conference & Trade Show.

Talking Medicare: DOJ Settlement Highlights Importance of Exclusion Testing

Talking Medicare: Recent DOJ Settlement Highlights Importance of Exclusion Testing

On July 17, 2018, the U.S. Attorney for the District of Maine issued a press release on a settlement that had been reached with an ambulance service in Maine. As a result of this settlement, the ambulance service agreed to pay $16,776.74 to resolve allegations that it had submitted false claims to the Medicare and Maine Medicare Programs.

While the Department of Justice’s press release referred to the matter as a civil health care fraud, that headline is somewhat misleading. The ambulance service was not alleged to “up-coded” its claims or to have billed for patients that did not require ambulance transportation. Rather, the ambulance service was accused of using monies paid to it by these federal health care programs to pay the salary and benefits of a woman hired to assist the company’s billing manager. The woman, who was not identified in news reports, had previously been excluded from participation in federal health care programs after surrendering her license as a pharmacy technician after being found to have inappropriately diverted certain controlled substances. The ambulance service apparently failed to conduct an exclusion test on this individual prior to placing her on its payroll. The ambulance service’s side of the story is discussed in greater detail in this article from the local newspaper.

This settlement provides a reminder of the potential liabilities associated with the employment excluded individuals. As the HHS Office of the Inspector General (OIG) noted in its May 2013 Special Advisory Bulletin, the effect of exclusion goes beyond direct patient care. The OIG noted that excluded individuals are prohibited from providing transportation services paid by a federal health care program, using the example of ambulance drivers and ambulance dispatchers. The OIG further indicated that excluded individuals cannot provide administrative and/or management services that are payable by federal health care programs, even if these administrative or management services are not separately billable. In the above-referenced case, the prohibition was applied to the wages and benefits payable to the excluded employee.

Do we need to conduct exclusion testing, and, if so, how frequently?

The OIG recommends that all health care providers conduct exclusion testing prior to an individual’s employment, and then periodically thereafter. However, the OIG takes no formal position on how frequently these periodic exclusion checks should be conducted. The OIG does note, however, that it updates its List of Excluded Individuals and Entities (LEIE) on a monthly basis.

Given the potential risks involved, I think monthly testing of all employees should definitely be considered a best practice. The hope is that this case serves as a cautionary tale for other ambulance providers.

Have an issue you would like to see discussed in a future Talking Medicare blog? Please write to me at bwerfel@aol.com.

CMS Extends Moratorium on Non-Emergency Ground Services

CMS Extends Temporary Moratorium on Non-Emergency Ground Ambulance Services in New Jersey and Pennsylvania

The Centers for Medicare & Medicaid Services (CMS) has announced that it intends to extend the temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers in the states of New Jersey and Pennsylvania.  The extended moratoria will run through January 29, 2019.  Notice of the extension of the temporary moratorium will appear in the Federal Register on August 2, 2018.

Section 6401(a) of the Affordable Care Act granted CMS the authority to impose temporary moratoria on the enrollment of new Medicare providers and suppliers to the extent doing so was necessary to combat fraud or abuse.  On July 31, 2013, CMS used this new authority to impose a moratorium on the enrollment of new ambulance providers in Houston, Texas and the surrounding counties.  On February 4, 2014, CMS imposed a second moratorium on newly enrolling ambulance providers in the Philadelphia metropolitan areas.  These moratoriums were subsequently extended on August 1, 2014, February 2, 2015, July 28, 2015, and February 2, 2016.

On August 3, 2016, CMS announced changes to the moratoria on the enrollment of new ground ambulance suppliers.  Specifically, CMS announced that: (1) the enrollment moratoria would be lifted for the enrollment of new emergency ambulance providers and supplier and (2) the enrollment moratoria on non-emergency ambulance services would be expanded to cover the entire states of New Jersey, Pennsylvania, and Texas.  At the same time, CMS announced the creation of a new “waiver” program that would permit the enrollment of new non-emergency ambulance providers in these states under certain circumstances.  The revised moratorium on newly enrolling non-emergency ground ambulance providers was subsequently extended on January 9, 2017 and July 28, 2017.

On September 1, 2017, CMS issued a notice on its website indicating that it had elected to lift the moratorium on the enrollment of new Part B non-emergency ambulance suppliers in Texas, effective September 1, 2017.  CMS indicated that this decision was made to assist in the disaster response to Hurricane Harvey.  CMS published formal notice of the lifting of this moratorium on November 3, 2017.

On January 30, 2018, CMS announced an extension of the moratorium on the enrollment of new Part B non-emergency ambulance suppliers in New Jersey and Pennsylvania.

CMS will need to make a determination on whether to extend or lift the enrollment moratorium on or before January 29, 2019.

NEW! AAA PreCon Workshop on Mandatory Cost Data Collection

AAA is excited to announce that this year we will be holding a full day pre-conference workshop at the AAA Annual Conference & Trade Show! Join industry experts Rebecca Williamson, Angie McLain, Asbel Montes, Kathy Lester, Scott Moore, and Brian Werfel to learn what the new cost data collection mandates will require and how you and your service can get ahead of the game and prepare for these changes.

Mandatory Cost Data Collection: When Is It Happening & How to Prepare

September 5, 2018 | 9:00 AM – 4:00 PM | MGM Grand, Las Vegas
$75 for Annual Conference attendees | $250 workshop-only

2018 federal legislation expanded Medicare cost reporting to ambulance services, although with some important differences from other Medicare reporters. Failure to meet these new reporting requirements could lead to significant sanctions including loss of Medicare revenue. In this session, we will review how we got to where we are, what the new mandates will require based on current regulations, and how best to prepare yourself and your service for the phase-in.

Nominations Open – AAA Board of Directors!

Call For Nominations Now Open!

Submit a Nomination

Submit Candidate Questionnaire

In accordance with the Bylaws of the American Ambulance Association, it is time to call for members in good standing that wish to serve on the Board of Directors. The AAA is now seeking candidates for the following positions:
  • President-Elect
  • Treasurer-at-Large
  • Secretary
  • Region I Director (CT, MA, ME, NH, NJ, NY, RI & VT)
  • Region II Director (AL, DE, DC, FL, GA, MD, MS, NC, PA, SC, VA, WV)
  • Region III Director (IL, IN, KY, MI, OH, TN WI)
  • Region IV Director (AR, IA, KS, LA, MN, MO, OK, ND, NE, SD, TX)
  • Region V Director (AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY

Individuals who wish to be considered for an elected position as President-Elect, Treasurer-at-Large, or Secretary must meet the following criteria:

1. Be an employee of and the designated representative of an Active member of the AAA, in good standing;

2. Be ready to devote time and effort to matters which concern the Board of Directors and to actively participate in all Board activities;

3. Be prepared to assist other AAA members with concerns and problems which relate to the ambulance industry and the workings of the AAA; and,

4. Understand that these positions provide no compensation for time or reimbursement for expenses. All travel-related expenses, including transportation, lodging and food are the responsibility of the individual and/or the sponsoring organization.

5. Be willing to comply with all governance policies of the association including, Conflict of Interest, Standards of Conduct, and Board Confidentiality, Public Comment and Lobbying Agreement (PDF).

6. Have served on the AAA Board within the past five (5) years prior to his or her declaration as a candidate for election as a President-Elect, Treasurer-at-Large, or Secretary.

Individuals who wish to be considered for an elected position as Regional Director must:

1. Be the designated representative of an Active member of the AAA, in good standing;

2. Be ready to devote time and effort to matters which concern the Board of Directors and to actively participate in all Board activities;

3. Be prepared to assist other AAA members with concerns and problems which relate to the ambulance industry and the workings of the AAA; and,

4. Understand that these positions provide no compensation for time or reimbursement for expenses. All travel-related expenses, including transportation, lodging and food are the responsibility of the individual and/or the sponsoring organization.

5. Be willing to comply with all governance policies of the association including, Conflict of Interest, Standards of Conduct, and Board Confidentiality, Public Comment and Lobbying Agreement (PDF).

6. Have served on at least one (1) Association committee within the past five (5) years prior to his or her declaration as a candidate for election as a Director.

There are no restrictions against an individual running for more than one position in the same election cycle, though no person shall hold more than one position simultaneously.

All those who wish to stand for election and believe they are qualified are requested to complete a Nomination Form as well as answer the Candidate Questionnaire which describes both their qualifications and reasons for wanting to participate in the leadership of the AAA.

(Please note that the may Nomination Form be completed by any designated contact employed by a AAA active member for him or herself, or on behalf of another designated contact employed at a fellow AAA active member service. The Candidate Questionnaire must be completed by the nominee.)

Candidates’ statements and pictures, as well as the position(s) for which they are running for will be listed on the AAA website once their candidacy has been certified by the Nominating Committee.

2018 Election Timeline

  • 5/14Nominations Open
  • 6/29 | Nominations Close
  • Week of July 9th | Approval of Candidates by AAA Board of Directors
  • 7/30 | Voting Opens
    Election will be paperless and held online. Ballots will be delivered to AAA Active Member primary contacts via email.
  • 8/27 | Voting Closes 11:59pm
  • 9/7 | Election results announced at the 2018 AAA Annual Conference & Tradeshow.

Both forms must be submitted to by Friday, June 29, 2018

Step 1: Nomination Form    Step 2: Candidate Questionnaire

Questions? Please contact acamas@ambulance.org for assistance.

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 this year.

A call comes in and your dispatcher does a perfect job of answering and scheduling the run. The EMT’s jump into the clean, fueled, and well stocked ambulance responding to the call. Then from out of nowhere, a car turns directly into the ambulance’s path rolling through a stop sign. Now what? You have two paramedics stranded on the side of the road who will be spending the next few hours on paperwork and drug testing. In addition, all the drugs and small equipment need to be removed or secured. Hopefully you have another unit to dispatch or your competitor may have already been called.

What happens next is key to getting maximum recovery for your losses caused by the accident.

Key items that help maximize your recovery from accidents:

  1. Educate and equip fleet drivers with the tools necessary to collect key accident information at the scene and relay it. This includes a description of the accident, clear color pictures of the accident scene, the damaged vehicles, and third-party driver’s license and insurance information.
  2. Gather as many witnesses as possible and statements from both drivers.
  3. On board videos are great, but if not, having a smart phone video of the damage and intersection can be very helpful if the liability is in question.
  4. Get an accurate and thorough estimate. Be aware that, for the most part, insurance companies are motivated to pay out the least amount possible to get the claim settled. Their adjusters are typically not trained accurately determine the damage to specialty vehicles or the equipment they may contain. Using a TPA with strong experience with commercial fleets is critical.

We are surprised how many firms don’t realize or understand what they are entitled to recover because of an accident where their driver was not at fault. Essentially, the law supports that the owner is entitled to the use of their “chattel” and compensation pursuant to the same. Here is an interesting titbit. Chattel is originally a Latin and old French term referring to moveable personal property. A good term to throw out at the next risk managers meeting to impress everyone. With that said, what you are entitled to and what shows up in your mailbox are two drastically different things. Insurance companies are motivated to pay the least amount possible and delay that payment as long as possible.

Most people assume that insurance companies make money when they generate more in premiums than they pay out in losses and expenses, but for the most part that’s not true. Most insurers are happy to break even on their underwriting and make their money by investing the premiums and keeping the investment returns.

What am I entitled to from a “not at fault” accident? There are a lot of factors influencing this, but essentially you are entitled to your physical damage, diminution of value, and loss of use/revenue. How much you are entitled to are the subjective negotiations that firms like ours engage in hundreds of times each day. Driver liability, statute of limitations and minimum policy limits vary from state to state. Typically, the state where the accident happens will be the applicable laws and regulations.

If I have a spare unit to take the place of the damaged vehicle, am I still entitled to Loss of Revenue? The short answer is yes, but getting the carrier to ink the check is another matter. There are real costs of having a spare unit which is why the law supports the loss of the use as a recoverable item. Acquisition cost, maintenance, licensing, certification, insurance, and storage are all costs incurred by having a spare unit.

Pursuing Loss Recovery

The following are steps fleets can take to help maximize recovery:

  1. Pursue all possible recoveries. There is often potential recovery from the third-party drivers in the form of an umbrella policy, company policy, or personal assets. Driver liability, statute of limitations and minimum policy limits vary from state to state. The key is to know which accidents offer what potential in which states, and then to pursue recovery using the latest industry tools as quickly as possible.
  2. Follow insurance industry documentation standards. The required forms need to be properly completed and submitted to the third-party driver’s insurance carrier. Knowing insurance industry regulations, standards, and the law are key to move the carriers to action. Technically, a carrier can wait 30 days after receiving a demand before taking action on the claim.
  3. A key component to Loss of Revenue is accurate records showing the income the unit generated prior to the accident. This is the hardest to recover and gets the most pushback from the insurance companies. Putting the data in a format that meets the insurance company’s needs varies by company.
  4. Even after the carrier has agreed to pay, be prepared to make a lot of follow-up calls and emails to get your claim paid. A common tactic used by carriers is to drag out the claim hoping you will either give up or accept less. Essentially wearing you down.

The second key recovery component is Diminution of Value (DV), or Loss of Market Value the vehicle suffers even after it is repaired. Age of the vehicle, miles, condition, and other factors determine this amount. Without a strong recovery plan or Third Party Administrator (TPA), we see significant diminution of value left on the table. The key here is strong data which supports your valuation utilizing use multiple sources and have extensive experience and a successful track record for recovering DV.

Getting accurate value when a vehicle is a total loss. The term “Total Loss” is an insurance term lacking legal definition. Carriers have often used title branding laws to determine if a vehicle is a “Total Loss”. While each state has different criteria for “branding” titles, vehicles can, and have been, paid as total losses with damage percentages well below the title branding statutes. Carriers often tout statements such as “Federal Guidelines” or “State Statutes” when attempting to settle claims. More accurately, legal entitlements are based upon what is called the Restatement of Torts, and defined by case law in each state. Typically, property and casualty insurance adjusters don’t understand these laws and again are motived to pay out the minimum possible. Engaging a firm that specializes in commercial fleet claims can provide an arm’s length transaction necessary to be pro-active on the front side in setting the claim up properly, which usually results in a higher recovery.

So how do you win at the recovery game? Well unfortunately you are in a game where the opponent is highly motivated to not pay or pay the least possible, has their own set of rules on how much you should get, and make most of their profit on dragging out a payment when they finally do decide to pay.

There are essentially three routes you can pursue.

  1. Handle the claims yourself. Unless you have extensive knowledge in the law and insurance industry, plus have ample time to talk to the voicemails of insurance carriers, this option may not be ideal.
  2. Let your insurance company handle the claim. They will pay your Physical Damage, but rarely does the policy have coverage for Loss of Revenue and Diminution of Value.
  3. Hire a TPA (Third Party Administer) to handle the claims for you. Select a firm with a long track record, experience with specialty vehicles, adequate technology, a strong legal department, and specializes in Loss of Revenue recovery. Make sure their fees are performance based and they only win if you do. They can recover Loss of Revenue, Diminution of Value (inherent and repair related) and other costs typically not recovered.

Few fleets have the number of trained personnel in each of these areas to adopt these best practices. If the fleet’s resources are already stretched to capacity, consider outsourcing to a TPA. The chances are the partnership will yield state-of-the-art best practices and more than pay for itself.

I hope you found this article helpful, don’t hesitate to contact me with any questions or to learn more.

Brian J. Ludlow is Executive Vice President for Alternative Claims Management. He is an entrepreneur and consultant to the insurance, financial, and transportation industries. Brian specializes in disruptive technologies. His firm has transformed the accident claims recovery process.

bludlow@AltClaim.com | 231-330-0515

Talking Medicare: GAO urges CMS to continue prior authorization

Talking Medicare: GAO urges CMS to continue prior authorization efforts

On May 21, 2018, the Government Accountability Office (GAO) issued a report to the U.S. Senate Finance Committee on the use of prior authorization models by the Centers for Medicare and Medicaid Services (CMS). The GAO was asked to examine: (1) the impact of prior authorization on total expenditures, and the potential savings for items or service subject to prior authorization, (2) the reported benefits and challenges of prior authorization, and (3) CMS’ monitoring of these programs, and its plans for future prior authorization. To conduct its study, the GAO looked at payment data and other information provided by CMS. The GAO also interviewed CMS, the Medicare Administrative Contractors (MACs), and selected provider, supplier, and beneficiary groups.

Prior authorization was first implemented by CMS in 2012 for certain power mobility devices (e.g., power wheelchairs) in seven states. Subsequent prior authorization models were implemented for non-emergency hyperbaric oxygen and home health services. Most relevant to our industry, CMS implemented a prior authorization model for repetitive, scheduled, non-emergency ambulance transportation in December of 2014. Originally, this model was implemented in only three states: New Jersey, Pennsylvania, and South Carolina. In January of 2016, the prior authorization model was expanded to include the states of Delaware, Maryland, North Carolina, Virginia, and West Virginia, as well as the District of Columbia.

The GAO’s key finding is that these prior authorization models have been effective in reducing Medicare’s expenditures for various items. The GAO’s analysis of actual expenditures found that the estimated savings from all demonstrations through March of 2017 could be as high as $1.1 to $1.9 billion. Given this fact, it should not be surprising that the GAO is calling on CMS to continue the use of prior authorization.

The majority of the data included in this report relates to non-ambulance services. However, I do want to highlight a few data points noted by the GAO.

From the model’s implementation in December 2014 through March 2017, MACs collectively handled more than 337,000 prior authorization requests, including a total of 3,231 requests for authorization of a repetitive, non-emergency, ambulance patient. This includes 2,620 initial requests, and 611 resubmissions (i.e., subsequent requests for prior authorization following the rejection of the initial request).

The GAO provisional affirmation rate for both initial and resubmitted authorization requests rose in each demonstration between the initial implementation date and March 2017. For example, the GAO noted that the affirmation rate (i.e., the rate at which patients are approved for repetitive ambulance transportation) during the first six months of the non-emergency ambulance model was 28 percent. This rose to 66 percent during the most recent six-month period (October 2016 through March 2017). The GAO noted that MAC officials attributed this increase, in part, to provider and supplier education, which they felt improved the documentation being submitted by providers and suppliers. While this is undoubtedly true, it is also likely the case that the MACs refined their approval process over time.

The GAO estimated the total potential savings from the prior authorization model for ambulance to be nearly $387.5 million from December 2014 through March 2017. Importantly, 90 percent of that savings was attributable to reductions in utilization in the original three states. Moreover, more than half the reduced expenditures took place within the first six months of the demonstration project.

In terms of fitting this report into the larger picture, I think it is best viewed as further confirmation of what we already suspected: namely, that the federal government perceives prior authorization to be an effective tool for combating the perceived overutilization of ambulance to transport patients to and from dialysis. CMS indicated as much when it adopted the program in 2014. Medicare payment data has borne out those expectations. Recently, CMS issued its first interim report on prior authorization’s effectiveness. The GAO’s report adds an independent imprimatur to that belief.

Big picture, all of the stars appear to be lining up for an expansion of prior authorization next year. Stay tuned!!

Have an issue you would like to see discussed in a future Talking Medicare blog? Please write to me at bwerfel@aol.com.

AAA To Honor 100 EMS Professionals at 2018 Stars of Life

For Immediate Release

AAA TO HONOR 100 EMS PROFESSIONALS AT 2018 STARS OF LIFE

 

Contact
Amanda Riordan
703-610-9018
ariordan@ambulance.org
www.ambulance.org

Washington, DC,  May 25, 2018– The American Ambulance Association (AAA) will celebrate the best and brightest of EMS professionals during its annual Stars of Life celebration June 11–13. At this year’s event, 100 individuals from across the United States, will be honored as the 2018 Stars of Life. The Stars of Life program pays tribute to the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure.

This year’s distinguished recipients are:

AAA President Mark Postma notes, “EMS professionals work tirelessly to provide life-saving health care every day across our nation. We are proud of the positive impact this year’s Stars of Life recipients have made within their communities and for the profession.”

During their time in Washington, the Stars of Life recipients, accompanied by executive hosts, will meet with members of Congress and congressional aides to discuss legislative issues critical to emergency medical services. In addition to honoring the Stars, Senator Debbie Stabenow of Michigan will be recognized as Legislator of the Year for her distinguished service, and 34 United States Senators and Representatives will receive Legislative Recognition Awards for their support of ambulance services.

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About the American Ambulance Association

Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system.

AAA Stars of Life 

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 100 EMS professionals will be honored as the 2018 Stars of Life. Meet the stars at www.stars.ambulance.org.

AAA Mission Statement

The mission of the American Ambulance Association is to promote health care policies that ensure excellence in the ambulance services industry and provide research, education, and communications programs to enable its members to effectively address the needs of the communities they serve.