Tag: 2020

2020 Medicare Reference Manual & Medicare Update Webinar

The 2020 Medicare Reference Manual and the 2020 Medicare Update Webinar are both available for purchase. Please see details below!

2020 Medicare Update Webinar

Thursday, April 30, 2020 | 2:00pm EST
Presenter: Brian Werfel, Esq.
$99 for AAA-Members | $198 for Non-Members

Join A.A.A. Medicare Consultant Brian S. Werfel, Esq. for an update on recent changes to Medicare’s coverage of ambulance services. This webinar coincides with the American Ambulance Association’s release of its 2020 Medicare Reference Manual. Brian will discuss recent changes in Medicare policy, including changes to the rules governing the enforcement of fraud and abuse, the appeals process, etc. We will also discuss Medicare’s proposed plan for the ET3 Program, the national expansion of the prior authorization model for scheduled non-emergency transports, and much more.

Of course, we will also discuss Medicare’s coverage of ambulance services during the current COVID-19 process. This will include a frank discussion of the issues related to medical necessity for the transportation of known or suspected COVID-19 patients, the coverage of transports to field hospitals and other alternative destinations, the current status of certain administrative rules like the Medicare patient signature requirement and the Notice of Privacy Practices, etc.

The session will include an extended Q&A period to address any and all questions from attendees. Purchase Webinar► 

*2020 Medicare Reference Manual Sold Separately* 

 

2020 Medicare Reference Manual 

$200 for AAA-Members | $400 for Non-Members
By David Werfel, Esq & Brian Werfel, Esq

The American Ambulance Association’s 2020 Medicare Reference Manual is a must-have for ambulance services that bill Medicare for transports.

EMS Week 2020

FOR IMMEDIATE RELEASE

March 16, 2020

EMS STRONG LAUNCHES “READY TODAY. PREPARING FOR TOMORROW.” CAMPAIGN TO HONOR EMS PROFESSIONALS

Campaign unifies the profession and brings awareness to National EMS Week, May 17-23, 2020

 WASHINGTON March 16, 2020– The American College of Emergency Physicians (ACEP), in partnership with the National Association of Emergency Medical Technicians (NAEMT), is proud to announce this year’s EMS STRONG campaign theme: READY TODAY. PREPARING FOR TOMORROW. The annual EMS STRONG campaign provides opportunities to recognize the Emergency Medical Services (EMS) community, enhance and strengthen the profession on a national level and celebrate National EMS Week, May 17-23, 2020.

The campaign brings together key organizations, media partners and corporate sponsors that are committed to recognizing and fortifying the EMS community, commending recent groundbreaking accomplishments and increasing awareness of National EMS Week.

“As we enter a new decade, we look ahead to the future of prehospital care. This future will include dramatic improvements in patient care, thanks to advances in research, information sharing and life- changing technology,” says William P. Jaquis, MD, FACEP, President of ACEP. “During National EMS Week, and throughout the year, we are proud to recognize EMS and fire professionals who tirelessly serve their communities and care for patients and their families every day.”

EMSSTRONG.org serves as a resource for stakeholders and the public to learn of inspiring stories from EMS practitioners, ways to get involved and EMS Week ideas, activities and templates. The website, which is also home to the annual EMS Week Planning Guide, encourages EMS professionals and stakeholders to promote their own industry and share content on social media platforms.

“The 2020 theme ‘Ready Today. Preparing for Tomorrow’ reflects what individual EMS professionals and organizations do every day as they respond to calls for help at any time and in any place,” explains

NAEMT President Matt Zavadsky. “The EMT and paramedic care of tomorrow will continue to expand into services that include community paramedicine, injury and illness prevention training and CPR and bleeding control education.”

EMS Week dedicates each weekday to specific themes under the “Ready Today. Preparing for Tomorrow.” umbrella. First responders are encouraged to plan activities and events around these themes in their communities.

  • Monday, May 18: EMS Education Day
  • Tuesday, May 19: EMS Safety Day
  • Wednesday, May 20: EMS for Children Day
  • Thursday, May 21: Save-A-Life Day (CPR & National Stop the Bleed Day)
  • Friday, May 22: EMS Recognition Day

Integral to the campaign’s success is the continuing involvement of the corporate sponsors, strategic association partners and strategic media partners.

Corporate Supporters include:

Genentech, American Red Cross, DrFirst, Health Scholars, Stryker, Teleflex, NHTSA/Office of EMS, National Registry of Emergency Medical Technicians (NREMT), AdvancedCPR Solutions, Aero Healthcare, Air Methods, Laerdal Medical, McKesson Medical-Surgical, North American Rescue, Sprint and Zoll.

Strategic Association Partners include:

American Ambulance Association, Association of Air Medical Services, Commission on Accreditation for Prehospital Continuing Education, Committee on Accreditation of Educational Programs for the EMS Professions, International Association of Fire Chiefs, International Association of Flight and Critical Care Paramedics, International Public Safety Association, National Association of EMS Educators, National Association of EMS Physicians, National Association of State EMS Officials, National EMS Management Association, National Fire Protection Association, National Registry of EMTs and National Volunteer Fire Council.

Strategic Media Partners include:

EMS1.com, EMS World and JEMS/EMS Today

For more information on the campaign, please visit: EMSSTRONG.org.

 

CMS Releases Update Guidance on Hospital EMTALA Obligations Related to COVID-19

On March 9, 2020, CMS published a memorandum to State Survey Agency Directors that provides updated guidance on the obligations of hospitals and critical access hospitals (CAHs) under the Emergency Medical Treatment and Labor Act (EMTALA).  This guidance was issued in response to numerous inquiries regarding the EMTALA obligations of these facilities as they struggle to respond to the COVID-19 pandemic.

Under EMTALA, hospitals and CAHs with emergency departments have an obligation to provide an appropriate medical screening examination to any individual that comes into the emergency department seeking examination or treatment of an emergency medical condition.  Hospitals and CAHs are further required to make a determination as to whether the patient actually has an emergency medical condition, and, if so, to provide stabilizing treatment within the hospital’s capabilities, or make appropriate arrangements to transfer the patient to a facility that does have the necessary capabilities.

The hospitals and CAHs had requested guidance on how they can fulfill their basic EMTALA obligations while minimizing the risks of exposure from COVID-19 infected individuals to their staff and other patients in their emergency departments.

Note: in summarizing the CMS guidance document, references to a “hospital” will include both hospitals and CAHs.

Acceptance of Patients Suspected or Confirmed to be Infected with COVID-19

 CMS indicated that hospitals with the capacity and the specialized capabilities needed to provide stabilizing treatments are required to accept transfers from hospitals without the necessary capabilities. CMS indicated that it would take into account the recommendations of the Centers for Disease Control (CDC) in assessing a hospital’s capabilities and capacity.  CMS further indicated that the presence or absence of negative pressure rooms (Airborne Infection Isolation Room (AIIR)) would not be the sole determining factor related to determining when an EMTALA transfer is required.  CMS is advising hospitals to coordinate with their state and local public health officials regarding the appropriate placement of individuals who meet specific COVID-19 assessment criteria, as well as the most current standards for treating patients confirmed to be infected with COVID-19.

CMS is further confirming that hospitals have the ability to set up alternative screening sites on the hospital campus, i.e., the initial medical screening exam does not need to take place in the emergency department.  CMS is confirming that individuals may be redirected to an alternative screening site after being logged into the emergency department.  This redirection can even take place outside the entrance to the emergency department.  Medical screening exams conducted in alternative screening sites must still be conducted by qualifying personnel (i.e., physicians, NPs, Pas, or RNs).

CMS is also indicating that hospitals may set up screening sites at “off-campus, hospital-controlled” sites.  Hospitals and community officials may encourage the public to go to these sites instead of the hospital for screening for influenza-like illnesses.  However, a hospital cannot tell an individual that has already presented at their emergency department to go to an off-site location for their medical screening exam.  Unless the off-campus site is already considered to be a dedicated ED (e.g., a free-standing ED) under EMTALA regulations, the EMTALA regulations would not apply to these off-site screening areas; however, the hospital would be required under its Medicare Conditions of Participation to arrange a referral/transfer to an appropriate hospital if the patient has a need for emergency medical attention. 

 Finally, communities may set up screening clinics at sites not under the control of a hospital.  These sites would not be subject to EMTALA.

EMTALA Obligations when a Screening Suggests Possible COVID-19 Infection

 To the extent a hospital determines, following a medical screening exam that a patient may be a possible COVID-19 case, the hospital is expected to isolate the patient immediately.  CMS indicated that it expects that all hospitals will be able to provide medical screening exams and initiate stabilizing treatment while maintaining isolation requirements.

Once an individual is admitted to the hospital or the emergency medical condition ends, the hospital has no further obligations under EMTALA.

CMS is further reminding hospitals that the latest screening guidance from the CDC calls for hospitals to contact their State or local public health officials when they have a case of suspected COVID-19.

CMS Grants State of Florida’s 1135 Waiver Request for Coronavirus Response

On March 16, 2020, CMS approved an 1135 Waiver request submitted by the State of Florida. The State had requested the flexibility to waive prior authorization requirements, streamline its Medicaid enrollment process, and allow care to be provided in alternative settings to the extent an existing health care facility needs to be evacuated. The key provisions of the waiver are summarized below:

1. Payments to Out-of-State Providers: Under current CMS coverage guidelines, the Florida Medicaid Program had the authority to reimburse out-of-state providers that were not enrolled in the Florida Medicaid Program provided certain criteria were met. However, this authority was limited to situations involving: (a) a single instance of care furnished over a 180-day period or (b) multiple instances of care furnished to a single Florida Medicaid beneficiary over a 180-day period. Under the waiver, CMS is removing the 180-day restriction for the duration of the emergency.

2. Expedited Enrollments: With respect to providers that are not currently enrolled in the Medicare Program or with another State Medicaid Agency, CMS is waiving the following screening requirements: (a) the payment of the application fee, (b) the fingerprint-based criminal background checks, (c) the required site visits, and (d) the in-state/territorial licensing requirements. Under the waiver, the state would still be required to check enrolling providers against the OIG exclusion list, and confirm that the out-of-state provider is properly licensed in their home state.

3. Cessation of Revalidation Efforts: CMS granted Florida the authority to temporarily cease the revalidation of enrolled in-state Medicaid providers and suppliers who are directly impacted by the emergency.

4. Waiver of Prior Authorization Requirements: CMS has granted Florida the right to waive any prior authorization requirements that are currently part of the State Medicaid Plan. This waiver applies to services provided on or after March 1, 2020, and will continue through the termination of the emergency declaration.

5. Waiver Allowing Evacuating Facilities to Provide Services in Alternative Settings: CMS will allow facilities, including nursing facilities, intermediate care facilities for individuals with intellectual and developmental disabilities, psychiatric residential treatment facilities, and hospitals to be reimbursed for services rendered during an emergency evacuation to an otherwise unlicensed facility. This waiver will extend for the duration of the declared emergency; however, CMS will require the unlicensed facility to seek licensure with the state after 30 days.

Understanding Medicare, Medicaid, and SCHIP Coverage of Ambulance Services under a Declared National State of Emergency

On March 13, 2020, President Donald J. Trump announced a national state of emergency in response to the COVID-19 pandemic. Previously, HHS Secretary Alex Azar had declared a public health emergency under Section 319 of the Public Health Service Act in response to COVID-19.

This has prompted many AAA members to ask what impact, if any, these declarations have on the coverage of ambulance services under federal health care programs?

The short answer is that these declarations give CMS the authority under Section 1135 of the Social Security Act to waive certain Medicare, Medicaid, and SCHIP Program requirements. This waiver authority includes, but is not necessarily limited to:

• Waiving certain conditions of participation and/or certification requirements;
• Waiving certain pre-approval requirements;
• Waiving the requirements that a provider or supplier be licensed in the state in which they are providing services;
• Waiving EMTALA requirements related to medical screening examinations and transfers; and
• Waiving certain limitations on payments for services provided to Medicare Advantage enrollees by out-of-network providers.

One situation where an 1135 waiver may be of use to an ambulance provider or supplier would be where the ambulance provider or supplier is sending vehicles and crews to a state that is outside its normal service area. The ambulance provider or supplier is unlikely to be licensed by the state in which it is responding. As a result, under normal circumstances, it would be ineligible for payment under federal health care program rules. The 1135 waiver would permit it to submit claims for the services it furnishes in the other state.

Of more immediate significance to the current national emergency, an 1135 waiver may permit hospitals and other institutional health care providers to establish an off-site treatment center for initial screenings of patients. For example, hospitals may establish triage sites in parking lots and other open spaces for the initial intake of patients suspected of being infected with the COVID-19 virus. In theory, this waiver could also extend to drive-thru testing sites to the extent they are operated by the hospital or another health care provider. When a hospital has obtained an 1135 waiver to operate an off-site treatment center, the off-site area becomes a part of the hospital for Medicare payment purposes. Therefore, ambulance transports to an approved off-site treatment area should be submitted to Medicare using the “H” modifier for the destination.

HealthAffairs: Hospital Capacity And Projected Need for COVID-19 Patient Care

Harvard’s Thomas C. Tsai, Benjamin H. Jacobson, and Ashish K. Jha have released to HealthAffairs their projections for hospital capacity and projected need for COVID-19. An excerpt is below.

Based on work by Lispsitch and colleagues, we used a middle-level estimate of COVID-19 infection rate of 40 percent. We assumed lengths of stay based on published studies. We calculated the capacity gap between current bed occupancy and anticipated COVID-19 demand assuming six, 12 and 18 month transmission curves. In our primary model, we made the very aggressive assumption that 50 percent of currently occupied beds could be freed up to care for COVID-19 patients.

Nationally, based on 40 percent prevalence of COVID-19 over the course of the pandemic, we estimate that 98,876,254 individuals will be infected, 20,598,725 individuals will likely require hospitalization and 4,430,245 individuals will need ICU-level care. We found that inpatient and ICU bed capacity to handle expected patient volumes varied significantly by Hospital Referral Region (See exhibits 1 and 2).

If the infection curve is not flattened and the pandemic is concentrated in a 6-month period, that would leave a capacity gap of 1,373,248 inpatient beds (274 percent potentially available capacity) and 295,350 ICU beds (508 percent potentially available capacity). If the curve of transmission is flattened to 12 months, then the needed inpatient and ICU beds would be reduced to 137 percent and 254 percent of current capacity. However, if hospitals can indeed reduce current bed occupancy by 50 percent and flatten the transmission curve to 18 months, then the capacity needed would be reduced to 89 percent of inpatient and 166 percent of ICU beds. If the infection rate is only 20 percent (low end of current estimates), we would largely be able to meet the needs for inpatient care if we flatten the curve to 12 months.

COVID-19 Message from President Aarron Reinert

Aarron Reinert
President
American Ambulance Association

Dear Fellow AAA Members,

I write to you today during what we all recognize as an extraordinary time for EMS. As we collectively serve on the very front lines of the COVID-19 epidemic, we know that the most challenging times are still ahead. However, I am heartened by the collective resolve of the members of the American Ambulance Association to provide 24/7 on-demand mobile healthcare, no matter the circumstances.

As President of the Association, I am sharing below a brief summary of the AAA’s activities to support its members in the face of this devastating disease.

COVID-19 Content & Approach

  • Coronavirus Working Group—AAA Region III Director Tom Tornstrom, Executive Director of Gundersen Tri-State Ambulance, has been appointed to lead the AAA Coronavirus Working Group. The team includes AAA’s lobbyists, leadership, staff, and members from across the nation. We meet frequently and collaborate constantly to track challenges and find solutions to EMS issues relating to COVID-19 response. Sample topics include:
    • First responder safety and wellness
    • Reimbursement for alternative destinations, treatment in place, and mobile testing
    • Paperwork reduction / waivers
    • Advocating for policies in federal legislation that support mobile healthcare and redacting those that can negatively impact the industry

Members will receive updates via our Digest e-newsletter as we continue to make progress on these and other issues.

  • Representation in Stakeholder Groups—From CMS to Congress to local mayors, AAA has representatives and members working with legislators, regulators, and officials at every level of government to advocate for EMS. Simultaneously, AAA leaders are working to showcase mobile healthcare’s unique strengths and capabilities for addressing the viral threat.
  • Member Newsletter—The frequency of our member Digest e-newsletter has been increased from weekly to near-daily to ensure that we are curating and communicating the most relevant and important information.
  • COVID-19 Archive—All AAA posts related to the virus can be found on our website. A COVID-19 resource link has been added to the top navigation of the AAA website for easy access by providers.

Association Events & Operations

  • Stars of Life—Out of an abundance of caution, the Stars of Life event in Washington has been canceled. All blocked rooms will be canceled and refunded by the hotel, and all attendee registration fees will be refunded by diflucan. Staff is working on the development of meaningful ways to celebrate 2020 Stars outside of the context of an in-person event.
  • Ambulance Cost Education (Cost Collection)—A plan is in place to move ACE Gold cost collection education from face-to-face to an interactive online learning environment. Subscribers can expect additional updates in early April.
  • Headquarters—Association staff is all working remotely whenever possible. Staff is adhering to strict health, hygiene, and social distancing. All order fulfillment, mail processing, and other functions have been moved offsite.

Please don’t hesitate to reach out to staff at info@ambulance.org or 202-802-9020 if we can be of any assistance. Thank you again for your service to your communities during this very difficult time.

Aarron Reinert
President, American Ambulance Association

2020 Stars of Life Canceled Due to COVID-19

On the afternoon of March 16, 2020, the American Ambulance Association board regretfully voted to cancel the 2020 Stars of Life. This action was taken out of an abundance of caution given the current COVID-19 pandemic. Attendees will be contacted with additional information within the next few days.

Thank you for your patience and flexibility.

Free Webinar: COVID-19 Issues Affecting the EMS Workplace

Free Webinar | Fri, March 20, 2020 |1:00 PM ET

Register Now

Summary
The world has changed in just a few short weeks and we all want answers to the tough questions facing EMS. Coronavirus (COVID-19) is also redefining how we deal with many issues in the EMS workplace. Join us as the nation’s top EMS legal experts from the American Ambulance Association and Page, Wolfberg & Wirth address the hot topics such as patient privacy, workplace safety, staff shortages, pay practices, worker’s comp and leave, discipline practices, liability and more. The webinar will include a Q&A so that you can ask these experts about the issues that matter most to you.

Speakers

Scott Moore, Esq.
Scott Moore is the owner of Moore EMS Consulting, LLC and an active EMT for nearly 30 years. Scott has held various executive positions, including Chief Executive Officer, Vice President, Director of Human Resources & Operations, at several ambulance services in Massachusetts. Scott is a licensed attorney, specializing in Human Resources, employment law, reimbursement, and compliance matters. Scott is the Human Resources & Operational Consultant to the American Ambulance Association (AAA) and frequently lectures at EMS conferences.


Ryan Stark, Esq.
Ryan Stark is a Managing Partner with Page, Wolfberg & Wirth, and is the firm’s resident “HIPAA guru.” Ryan is a featured speaker in PWW seminars and webinars, including the firm’s signature abc360 Conference, where he hosts the abc360 Game Show. Ryan developed, and is the primary instructor for the nation’s first and only HIPAA certification for the ambulance industry. He also co-authored PWW’s widely used Ambulance Service Guide to HIPAA Compliance.


Stephen Wirth, Esq., EMT-P
Attorney/Founding Partner, Page, Wolfberg & Wirth, LLC
Steve Wirth is a founding partner of the national EMS law firm Page, Wolfberg & Wirth, LLC. Steve has worked in virtually every facet of EMS in a four- decade career – as first responder, firefighter, EMT, paramedic, flight paramedic, EMS instructor, fire officer, and EMS executive. Steve brings a pragmatic, compassionate, and business‐oriented perspective to his diverse legal practice and served for nearly a decade as senior executive of a mid‐sized air and ground ambulance service.

Sponsored By:

By registering for this program, you consent to share the registration information (not including your email address) with the program’s sponsor.

Register Now

Coronavirus (COVID-19) Impacts on the EMS Workplace

There has been a great deal activity and press coverage over the past few weeks relative to the Coronavirus (COVID-19). This activity has generated several questions from EMS organizations regarding how to handle the impact on the workplace. Healthcare workers have been identified by the Occupational Safety and Health Administration (OSHA) as a group of workers who are at an increased risk of exposure to COVID-19. There are many steps EMS organizations can take to best prepare their workplace and protect their personnel.

EMS agencies are already required to follow and maintain OSHA’s Infection Control Standards for Bloodborne and Airborne Pathogens (29 CFR 1910.1030). If EMS organizations and their employees are diligent in maintaining these standards, they will already be doing nearly everything that is being recommended for employers to combat the spread of COVID-19. The Centers for Disease Control (CDC) released their Interim Guidance for Businesses and Employers, which includes additional practical recommendations for employers to utilize to further combat the spread of COVID-19, including:

  1. Actively encouraging sick employees to stay home;
  2. Separating sick employees from the rest of the workforce;
  3. Encouraging workers to stay home when sick, respiratory etiquette, and hand hygiene by all employees;
  4. Performing routine environmental cleaning;
  5. Advising employees before traveling to take certain steps.

This guidance is intended to be a refresher for employers. The recommendations by the CDC are consistent with best practices for employers regardless of a potential pandemic. However, our workforce can become complacent and it is important that EMS organizations remind their teams to be diligent and have supervisory staff monitor for adherence to these practices and company policies.

Frequently Asked Questions

Over the past week there have been several questions posed by EMS organizations on employer related issues related to COVID-19. We thought we would share those questions and encourage members to reach out with questions not addressed in this FAQ. We will be sure to share those questions with members and will provide additional guidance as it becomes available.

Are there any limits to the medical questioning or screening of current or potential employees?

Yes, Employers are limited when performing medical screenings or making medically related inquiries of employees or job candidates regardless of the current COVID-19 virus concerns. Often, medical screenings or inquiries can identify medical conditions which are protected under the Americans with Disabilities Act (ADA). To the extent to which they are permitted, any medical inquiry or screening must be job related and consistent with business necessity. In those circumstances, any information must be kept confidential.

The Equal Employment Opportunity Commission (EEOC) re-released Pandemic Preparedness in the Workplace and the Americans with Disabilities Act which provides guidance for employers on how to prepare for a pandemic in the workplace while maintaining compliance with the ADA.

Employer Permitted Screening/Questioning

  1. Questions designed to identify non-medical reasons for work absences (such as public transportation interruptions)
  2. Post-offer medical examinations required of all similarly situated employees in same job category.
  3. During a declared pandemic, employers can ask employees if they are experiencing pandemic-like symptoms. Responses must be kept confidential, consistent with other employee-related medical information.
  4. Taking employee’s temperatures is permitted in a widespread pandemic but this may not be a reliable manner for identifying those employees ill with the COVID-19 virus.
  5. Employers can inquire about potential exposure to pandemic if the employee traveled to an area affected by the COVID-19 pandemic.
  6. Employers can ask an employee if the reason an employee missed work was for a medical reason.

What do we do if we have an employee who is concerned about exposure and wishes to miss work? Additionally, what if the employee’s concern is due to an underlying medical condition, such as pregnancy, and asks to stay out of work?

There are several important issues to address with both questions. First, employers need to review all company policies regarding leave from work to ensure compliance with the relevant leave laws including, leave as an accommodation under the ADA, Family and Medical Leave Act (FMLA), and state-level Paid FMLA or Sick Leave laws. Additionally, employers should review their policies regarding any other paid or unpaid leave to be certain that all policies clearly delineate how leave requests are handled under these policies.

For the most part, when an employee is seeking to miss work due to exposure concerns, employers should handle these requests as they would any other requested leave from work. This is where it is important to utilize your Human Resources (HR) professionals. HR can evaluate the request for leave to ensure that the reason the employee is requesting the leave isn’t due to an underlying disability under the ADA or a “serious health condition” under FMLA. In both instances, an employer has numerous obligations and may be required to approve the leave. In some instances, the employee could be seeking FMLA due to a family member who is ill with COVID-19 who they must care for. In these instances, employers would follow their normal FMLA practices.

As it relates to the first employee, the presumably healthy employee who is concerned with being exposed to COVID-19, any leave would be provided consistent with the employer’s attendance and time off policies. This is different than how you would address the employee who is pregnant and seeking to miss work due to concerns of virus exposure. Pregnancy and pregnancy related medical conditions can qualify as a “disability” under the ADA.

Pregnancy itself is not necessarily a “disability” under the ADA. Only when the pregnancy or a pregnancy related medical condition interferes with one or more major life activities, may it qualify as a “disability” under the ADA. Employers are required to engage in the “interactive process” to determine if the employee can be provided with a “reasonable accommodation” that would permit the employee to perform the essential functions of their position. A reasonable accommodation can include leave from work. It is important that you document these requests and the subsequent process to ensure consistent handling and record keeping.

These can be incredibly difficult issues to handle, especially with all the information and media attention surrounding this virus. Members who need assistance with these potentially challenging compliance issues can contact the AAA and its consultants for assistance.

What should we do if an employee is exposed to, or suspected of having contracted COVID-19?

OSHA has created a COVID-19 Resources Webpage to assist employers with planning and addressing employer issues related to the Coronavirus. In addition, the CDC’s guidance for employers provides recommendations and strategies to prepare for, and deal with, COVID-19 in the workplace. This includes how to address the employee-related aspects of this virus.

However, under the General Duty Clause of OSHA, employers must “furnish to each of his employee’s employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” This includes removing known hazards from the workplace, including sick or contagious employees.

Aside from the efforts to prepare and address exposures, employers have been seeking guidance from a workers’ compensation perspective and how to handle quarantines and exposures for employees. It is important to remember that an occupational exposure to COVID-19 is no different than any other occupational exposure. EMS organizations should be sure to do the following:

  • Review their company policies relative to work injuries, exposures, and illnesses to be sure that they are clearly drafted and instruct both employee and supervisors what to do in the event of an exposure.
  • Ensure you have reviewed the Infection Control and Bloodborne and Airborne Pathogens Standards and that your employees have access to, and utilize their Personal Protective Equipment (PPE).
  • Confirm that there is adequate workplace postings and communications to ensure that all employees understand how to report any suspected occupational exposure.
  • Confirm with all management personnel that they understand how to appropriately investigate any workplace exposure in collaboration with human resources or company safety or occupational health officer.
  • Contact the Infection Control Officer at the healthcare facilities in your catchment area to ensure that they have the appropriate contact information for your service in the event that they need to contact your organization due to a known exposure.
  • Contact the public health agency in your catchment area to ensure that your organization is engaged with public health officials in your service area to stay informed.
  • Be sure that employees understand and are leaving a copy of the Ambulance Patient Care Report at a receiving facility at the time of transport to ensure that the receiving facility’s Infection Control Officer can notify the EMS organization in the event that an ambulance patient is later determined to have, or be suspected of having COVID-19.
  • If an employee reports exposure to COVID-19, employers should notify their workers compensation insurance carrier to begin the claims process.
  • In most states, being exposed to a contagious disease or illness is not itself compensable under workers’ compensation. To be compensable under most state worker’s compensation laws, the employee has to actually contract the contagious illness or disease and be able to show that the contagious disease or illness exposure occurred in the course of their employment. Some professions, such as healthcare, are inherently more likely to be exposed to the contagious disease or illness. Often, healthcare workers are still required to show a “but for” causation. If the employee can meet this burden, then the workers’ compensation claim for this illness will likely be compensable.
  • Employees who have a workplace exposure and have been placed in quarantine or are being treated will be handled a bit differently. These exposures or illnesses would be handled like any other occupational exposure or illness. The employee should complete an Injury & Illness Incident Report form to ensure that the employer has all of the information needed to appropriately investigate and report the illness, both to their workers compensation insurance carrier and on their OSHA Log of Work-Related Injuries & Illnesses.

Can I make my employees stay home if they have been exposed or are exhibiting symptoms of COVID-19? If so, must I pay employees for the time missed?

Yes, generally you can require an employee to stay home from work. Employers have an obligation under the General Duty Clause of OSHA to provide a safe workplace for all employees. This would include protecting the health and safety of the other workers in your workplace.

The second part of this question will depend on numerous factors including, any applicable state paid leave laws, company sick or paid time off benefits, or other past company practices which paid employees for similarly missed time.

The bottom line, you must pay the employee consistent with any mandatory state sick leave requirements, paid company leave benefits, or consistent with any past pay practices for pay in such situations. The goal will be to treat the employee consistent with all federal or state laws, company policy, or past business practice. When employers treat similarly situated employee differently, they run the risk of potential discrimination claims.

Can I reduce staffing or require some workers to work from home or telecommute?

Yes, while most of the job duties performed by EMS organization workers are the kind that require presence at the workplace, there are some administrative positions that can be performed remotely or at home. In these instances, employers still have several things to consider before asking employees to work remotely.

First, employers who decide to have employees work remotely must ensure that the work performed remotely is done so in a compliant manner. For example, billing personnel working remotely will have to access Protected Health Information (PHI) during the course of performing their duties. It is important that the EMS agency ensures that the Administrative, Physical, and Technical safeguards required under the Privacy and Security Rule of the Health Insurance Portability and Accountability Act (HIPAA) are complied with in that remote setting.

Second, any FLSA non-exempt employee needs to continue to track all time worked to ensure the employer can accurately pay all employees. Employers must establish policies, to the extent that they do not already exist, that govern remote workers or telecommuting. Employers should review all existing organizational policies and ensure that they are adapted to address remote working or telecommuting. This includes addressing the steps employees need to take should they need to be absent from work, including how to “call out sick” or must miss work.

Third, employers need to ensure that employees who require an ADA reasonable accommodation in the workplace can still be provided that accommodation when working remotely, if needed. It is important for employers to remember that they are still required to comply with all work-related laws and regulations even for remote or telecommuting workers.

Do employers have to pay workers who are out of work?

That depends on the reason for the employee being out of work, your state law, and the employer’s policies.

  • Voluntary absence from work due to employee’s concern of future exposure?

    Absent any state paid leave requirements, if the employee has voluntarily decided not to come to work due to their concern of exposure to the virus, then you would need to pay them consistent with your organization’s policy regarding paid time off. If the employee has no paid time off available, then the employer is not required to pay them.
    There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Employers with labor unions should consult their collective bargaining agreements (CBA) for any paid time off provisions.

  • Voluntary isolation or quarantine following suspected exposure?

    Generally, employees who are placed in quarantine due to exposure to COVID-19 are not compensable under most state’s workers’ compensation laws. Nothing prevents an employer from filing a claim with their workers’ compensation insurance carrier. However, it is highly unlikely that the insurance carrier will consider this a compensable illness or injury.

    As stated above, absent any state paid leave requirements, if the employee does not come to work due to their exposure to the virus, then you would need to pay them consistent with any state-mandated paid time off or your organization’s policy regarding paid time off. If the employee has no paid time off available, then the employer is not required to pay them.

    There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Again, employers with labor unions should also consult their collective bargaining agreements (CBA) for any paid time off provisions.

  • Employee absence due to acquiring or exhibiting symptoms of COVID-19?

    If an employee misses work due to acquiring COVID-19 or exhibiting the virus’ symptoms, the employer should follow their normal work-related illness practices as provided under workers’ compensation. Whether the illness is compensable under workers’ compensation is determined under state workers’ compensation law. Typically, if an illness is compensable under workers’ compensation, the first several days are unpaid and can be paid under any state mandated sick or employer paid time off policy.

    If the employee has no paid time off available, then the employer is not required to pay them. There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Employers with labor unions should also consult their collective bargaining agreements (CBA) for any paid time off provisions.

Does employee absence from work due to COVID-19 qualify for Family & Medical Leave under the Family & Medical Leave Act (FMLA)?

Generally, employees who exhibit a mild case of COVID-19, which does not require continuing treatment or hospitalization, it is highly unlikely that the individual’s condition would rise to the level of a “serious health condition” as defined under the Family & Medical Leave Act (FMLA) leave. If the employee has a more serious case of the illness, then the employee could qualify for job protected leave under FMLA. In that case, the employer should follow the required steps under FMLA, including furnishing the employee with a Notice of Eligibility and Rights & Responsibilities, Certification of Health Care Provider Employee’s Serious Health Condition, and subsequent FMLA Designation Notice as required under FMLA.

However, if the employee is caring for a parent or child with a serious health condition, the virus itself, or another underlying medical condition that is worsened by the virus, it may trigger job-protected leave under FMLA. Under FMLA, the employer would provide the employee the Notice of Eligibility and Rights & Responsibilities, the Certification of Health Care Provider for Family Member’s Serious Health Condition, and the Designation Notice and would handle consistent with FMLA. It is recommended that all employee leave is tracked and logged for record keeping purposes and to ensure consistent handling of leave requests.

Employee absences that are caused by their need to provide childcare due to their child’s daycare or school closure, would not trigger protected leave under FMLA. Such leave may be covered under an employer’s other paid or unpaid time off or leave policies or under state required paid or unpaid leave.

What options does an employer have when it comes to staffing shortages created by COVID-19?

Employers should set a staffing contingency plan and policies if the employer has difficulty with staffing due to a pandemic. This policy should be broadly communicated to all employees. Many EMS agencies have hold-over policies that provide that an employee may have to stay on duty for a subsequent shift due to staffing shortages.

In these instances, it is best practice to set parameters around these policies, including the circumstances under which the policy will be implemented, notice to the hold-over employee, and considerations for maximum continuous and total weekly working hours. In addition, the policy should provide for employee self-reporting and fatigue protocols which include non-retaliation protections for employees who express fatigue or safety concerns.

Employee who are held over must be paid consistent with federal, state, and local wage laws, including any applicable overtime provisions of the Fair Labor Standards Act (FLSA). Non-exempt salaried employees should be paid consistent with federal, state, or local overtime wage laws. FLSA Exempt employees do not have to be paid overtime for hours worked over forty (40) hours.

Employers who have a unionized workforce should refer to the Collective Bargaining Agreement (CBA) for any provisions impacted by hold-over or pay practices.

What can/should we do if an employee refuses to work with another employee due to concerns of exposure to COVID-19?

It is important for employers to learn or understand why this employee is refusing to work with the other individual. If the employee is refusing to work with the other individual because that individual is exhibiting virus-like symptoms, then that employee should not be in the workplace anyway. Under OSHA, employers have an obligation to furnish to employees a place of employment which is free from recognized hazards that are causing or are likely to cause death or serious physical harm to other employees. This would include exposure to employees suspected of having COVID-19.

Under OSHA, an employee is only entitled to refuse to work if they believe they are in imminent danger. OSHA has recommended actions for an employee to take if they believe performing the task or working would pose an imminent danger. The right to refuse work is protected if all of the following conditions are met:

  • Where possible, you have asked the employer to eliminate the danger, and the employer failed to do so; and
  • You refused to work in “good faith.” This means that you must genuinely believe that an imminent danger exists; and
  • A reasonable person would agree that there is a real danger of death or serious injury; and
  • There isn’t enough time, due to the urgency of the hazard, to get it corrected through regular enforcement channels, such as requesting an OSHA inspection.

You should take the following steps:

  • Ask your employer to correct the hazard, or to assign other work;
  • Tell your employer that you won’t perform the work unless and until the hazard is corrected; and
  • Remain at the worksite until ordered to leave by your employer.

However, if the employee is refusing to work with the other employee because of their belonging to, or being a member of, a category of people who are protected under Title VII of the Civil Rights Act or one of the other anti-discrimination statutes, that would violate law and an employer would be required to address this behavior. It is equally important that employers monitor workplace behavior, and the treatment of their employees by individuals not employed by the EMS organization, to ensure that they are not subject to direct or indirect discriminatory actions. This includes patients who refuse to be treated by your EMS personnel due to discriminatory motives or fears.

Important Reminder

Due to the nature of the work performed by EMS personnel and other healthcare workers, our workers are more likely than the general population to be exposed to workplace hazards, including viruses like COVID-19. It is important to remember that our teams face far greater a risk on a daily basis than those associated with this virus. Employers should remind their staff of the available benefits and services, such as Employee Assistance Programs, Support for Medics, Short-Term Disability, and available paid time off, should they wish to utilize them during this stressful time.

If we ensure that our employees are following our occupational safety practices and policies, they will significantly reduce the likelihood of workplace exposure or injury. This will not happen without every individual on the team taking ownership of fostering a culture of safety. Communication and monitoring are key to maintaining a safe work environment and significantly ease worker’s fears surrounding this virus.

As always, the American Ambulance Association and its team of staff and consultants can assist EMS organizations with these challenges. Be sure to visit the AAA website for more information.

AMBY Award Nominations Open!

Nominations for the 2020 AMBY Awards close May 15! The AMBYs recognize excellence in the ambulance profession and the ingenuity and entrepreneurial spirit that epitomize AAA members. Winners will are awarded during the AAA Awards Reception at our Annual Conference & Tradeshow, In addition, all entries will be shared with the AAA membership on the website, in the association’s mobile event app and as an online publication.

Learn more, and nominate now!

COVID-19 Update II for EMS

First Case of 2019 Novel Coronavirus in the United States

The New England Journal of Medicine has rapidly published a peer-reviewed paper on the Snohomish County WA ‘Patient 1’. This was the first reported case of COVID 19 in the US. This seminal document, which given the magnitude of the case and its initial findings is released in full here

The work by Michelle L. Holshue, M.P.H., Chas DeBolt, M.P.H., Scott Lindquist, M.D., Kathy H. Lofy, et al for the Washington State 2019-nCoV Case Investigation Team was turned round in just over 5 weeks and below is an ‘Executive summary’ ( as extracted from the paper) but the full paper and range of results should be read in full.

Patient Presentation

On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China. The patient stated that he had seen a health alert from the U.S. Centers for Disease Control and Prevention (CDC) about the novel coronavirus outbreak in China and, because of his symptoms and recent travel, decided to see a health care provider.

On admission, the patient reported persistent dry cough and a 2-day history of nausea and vomiting; he reported that he had no shortness of breath or chest pain. Vital signs were within normal ranges. On physical examination, the patient was found to have dry mucous membranes. The remainder of the examination was generally unremarkable. After admission, the patient received supportive care, including 2 liters of normal saline and ondansetron for nausea.

Viral Presence

Both upper respiratory specimens obtained on illness day 7 remained positive for 2019-nCoV, including persistent high levels in a nasopharyngeal swab specimen (Ct values, 23 to 24).

Stool obtained on illness day 7 was also positive for 2019-nCoV (Ct values, 36 to 38).

Nasopharyngeal and oropharyngeal specimens obtained on illness days 11 and 12 showed a trend toward decreasing levels of virus

Day 8: Condition Improves

On hospital day 8 (illness day 12), the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present. His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea. As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the exception of his cough, which is decreasing in severity.

History Taking

This case report highlights the importance of clinicians eliciting a recent history of travel or exposure to sick contacts in any patient presenting for medical care with acute illness symptoms, in order to ensure appropriate identification and prompt isolation of patients who may be at risk for 2019-nCoV infection and to help reduce further transmission. Finally, this report highlights the need to determine the full spectrum and natural history of clinical disease, pathogenesis, and duration of viral shedding associated with 2019-nCoV infection to inform clinical management and public health decision making.

Conclusion

There is little doubt that this paper is about to become a globally sited document as we continue to deal with COVID 19. As far as EMS and our first response to it goes, the paper reinforces the key actions currently being taken

 

Sample COVID-19 Policies for Mobile Healthcare Providers

Thank you to the following organizations for sharing their policies as examples.

Global Medical Response maintains a COVID-19 page to provide information to all members of the GMR community—clinicians and non-clinicians.

Updates from GMR Chief Medical Officer, Dr. Ed Racht

GMR Procedures

General Information for Caregivers

Compliance

HIPAA Reminder

FirstWatch Solutions

The intention of the COVID-19 Process/Policy Template is to provide agencies, medical directors, or others who want to utilize it, an outline/template on which to build an agency-specific policy/protocol to address COVID-19. This includes suggestions for development and/or oversight committees, outside partners and stakeholders, as well as preparation and process for EMS workers who provide best practice care for patients as well as providing for the protection of pre-hospital providers and medical director(s). Its application is totally up to the user.

This document is meant to be a living document that can be revised as circumstances or guidance changes. It can also be a discussion piece for those who choose to develop a different type of policy but may want to use some of the components of the document as a starting point.

Agency Guidance

CDC Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States
NEW March 6, 2020: CMS COVID-19 FAQs for Healthcare Providers (PDF Download)

March 5, 2020: CMS issued a second Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs.  https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests

March 4, 2020: CMS issued a call to action to healthcare providers nationwide and offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare. https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus

February 13, 2020: CMS issued a new HCPCS code for providers and laboratories to test patients for COVID-19.  https://www.cms.gov/newsroom/press-releases/public-health-news-alert-cms-develops-new-code-coronavirus-lab-test

February 6, 2020: CMS gave CLIA-certified laboratories information about how they can test for SARS-CoV-2. https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/notification-surveyors-authorization-emergency-use-cdc-2019-novel-coronavirus-2019-ncov-real-time-rt

February 6, 2020: CMS issued a memo to help the nation’s healthcare facilities take critical steps to prepare for COVID-19.  https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov

AAA Releases 2020 Medicare Rate Calculator

AAA 2020 Medicare Rate Calculator Now Available!

The American Ambulance Association is pleased to announce the release of its 2020 Medicare Rate Calculator tool. The AAA believes this is a valuable tool that can assist members in budgeting for the coming year. This calculator has been updated to account for recent changes in Medicare policies, including the 2020 Ambulance Inflation Factor (0.9%) and the continuation of the current temporary add-ons.

To access the Rate Calculator, please CLICK HERE.

2020 calculator

COVID-19 Coronavirus EMS Advisory 1

This guidance is written to offer American Ambulance Association members the situational background and a list of resources and websites with which to draw guidance and further updates on the latest situation with COVID-19, colloquially referred to as “Coronavirus.” Key information for this update has been drawn from the NHTSA EMS Focus series webinar What EMS, 911 and Other Public Safety Personnel Need to Know About COVID-19, which took place on February 24, 2020. The on-demand recording is available below.

General Information

Background

The COVID-19 Coronavirus Disease was first reported in Wuhan China in December 2019. CDC identifies that it was caused by the virus SARS – CoV-2. Early on, many patients were reported to have a link to a large seafood and live animal market. Later, patients did not have exposure to animal markets which indicates person-to-person transmission. Travel-related exportation of cases into the US was first reported January 21, 2020. For reference the first North American EMS experience of  COVID-19 patient transport, including key lessons learned, can be found in the EMS 1 article Transporting Patient 1.

Spread and Identification

Global investigations are now ongoing to better understand the spread. Based on what is known about other coronaviruses, it is presumed to spread primarily through person-to-person contact and may occur when respiratory droplets are produced when an infected person costs or sneezes. Spread could also occur when touching a surface or object that has the virus on it and when touching the mouth, nose, or eyes. Again, research is still ongoing, and advice and guidance will inevitably follow.

For the cases that have been identified so far, those patients with COVID19 have reportedly had mild to severe respiratory illness with symptoms including fever and shortness of breath. Symptoms have typically appeared 2 to 14 days after exposure. Both the WHO and CDC advise that patients that have been to China and develop the symptoms should call their doctors.

COVID-19 Prevention and Treatment

To date, 30 international locations, in addition to the US, have reported confirmed cases of   COVID-19 infection. Inside the US, two instances of person-to-person spread of the virus have been detected. In both cases, these occurred after close and prolonged contact with a traveler who had recently returned from Wuhan, China.

The CDC activated its Emergency Operations Center (EOC) on January 21 and is coordinating closely with state and local partners to assist with identifying cases early; conducting case investigations; and learning about the virology, transmission, and clinical spectrum for this disease. The CDC is continuing to develop and refine guidance for multiple audiences, including the first responder and public safety communities.

As at the date of publication there is still no specific antiviral treatment licensed for   COVID-19, although the WHO and its affiliates are working to develop this.

The following are recommended preventative measures for  COVID-19 and many other respiratory illnesses:

  • Wash your hands often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizer with at least 60% if soap and water are not readily available.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid contact with people who are sick.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw it away.
  • Clean and disinfect frequently touched objects and surfaces.

Interim Guidance for EMS and 911

The Centers for Disease Control (CDC) has issued its Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States.

The guidance identifies EMS as vital in responding to and providing emergency treatment for the ill. The nature of our mobile healthcare service delivery presents unique challenges in the working environment. It also identifies that coordination between PSAPs and EMS is critical.

Key points are summarized below:

Recommendations for 911 PSAP Locations

The link between PSAPs and EMS is essential. With the advent of COVID19 there is a need to modify caller queries to question callers and determine the possibility that the call concerns a person who may have signs or symptoms and risk factors for COVID19.

The International Academy of Emergency Dispatch (IAED) recommends that agencies using its Medical Priority Dispatch System (MPDS) should use its Emerging Infectious Disease Surveillance (EIDS) Tool within the Sick Person and Breathing Problem protocols. For those that are not MPDS users, IAED is offering its EIDS surveillance Tool for Coronavirus, SRI, MERS and Ebola-free of charge under a limited use agreement.

Recommended Personal Protective Equipment (PPE)

The CDC recommends that while involved in the direct care of patients the following PPE should be worn:

  • Single pair of disposable examination gloves
  • Disposable isolation gown
  • Respiratory protection (N95 or higher)
  • Eye Protection (goggles or disposable face shield)

EMS Transport of a Patient Under Investigation (PUI) or Patient with Confirmed COVID19

  • Notify receiving healthcare facility so appropriate precautions can be put in place
  • Discourage family and contacts from riding in transport vehicle
  • Isolate the vehicle driver from the patient compartment by closing the windows between compartments and ensuring that the vehicle ventilation system is set to the non-recirculated mode
  • Document patient care

Cleaning EMS Transport Vehicles After Transporting PUI or Patient

  • Don PPE for cleaning with disposable gown and gloves, facemask, and goggles or face shield if splashes are anticipated
  • Routine cleaning and infection procedures should follow organizational standard operating procedures
  • Use protect use products with EPA-approved emergent viral pathogens claims

Once transport is complete, organizations should notify state or local public health authorities for follow up. Additionally agencies should (if not done already) develop policies for assessing exposure risk and management of EMS personnel, report any potential exposure to the chain of command, and watch for fever or respiratory symptoms amongst staff.

Employers Responsibilities

While not specific to COVID-19, agencies should:

  • Assess current practices and policies for infection control
  • Job- or task-specific education and training
  • PPE training and supply
  • Decontamination processes and supplies

Local EMS Considerations

  • PPE supplies
  • 911 and EMD call taking activities
  • Appropriate approach to potential patients
  • Educational resources for EMS personnel
  • Interaction with local public health/healthcare systems/emergency management
  • Interaction with local fire and law enforcement
  • Considerations for local jails

Further Reading

Conclusion

The COVID19 situation constantly evolving. Agencies should defer to their local EMS authorities, Public Health departments, and the CDC for definitive guidance. Going forward, the AAA will continue to both monitor the disease and alert issues to the membership.

CMS Posts 2020 Public Use File

On December 2, 2019, CMS posted the 2020 Ambulance Fee Schedule Public Use Files. These files contain the amounts that will be allowed by Medicare in calendar year 2020 for the various levels of ambulance service and mileage. These allowables reflect a 0.9% inflation adjustment over the 2018 rates.

The 2020 Ambulance Fee Schedule Public Use File can be downloaded from the CMS website by clicking here.

Unfortunately, CMS has elected in recent years to release its Public Use Files without state and payment locality headings. As a result, in order to look up the rates in your service area, you would need to know the CMS contract number assigned to your state. This is not something the typical ambulance service would necessarily have on hand. For this reason, the AAA has created a reformatted version of the CMS Medicare Ambulance Fee Schedule, which includes the state and payment locality headings. AAA members can access this reformatted fee schedule at the link below.

2020 Ambulance Fee Schedule▶

 

Cost Data Collection: So You’ve Been Selected—Now What?

It’s finally here! For almost a decade the American Ambulance Association has been preparing for this moment: collecting cost data in order to justify the reimbursement inadequacies of our current payment system. As Benjamin Franklin stated, “By failing to prepare, you are preparing to fail.” So prepare we did!

Our research indicated that due to industry capacity, a provider sample and survey approach would be preferable to a mandatory cost reporting structure. Congress agreed! Our research indicated that different organizational structures made us unique healthcare providers and as such, EMS’s special nature should be considered in the collection tool developed. Congress agreed! No one knows our industry better than we do and the final rule from the Centers for Medicare and Medicaid Services indicates they listened!

So your ambulance service was selected for the 2020 reporting period—now what? Here is your 10 STEP PLAN.

STEP 1: Sign up for the latest information on ambulance cost data collection.

Subscribe to email updates from the American Ambulance Association’s Ambulance Cost Education page, www.ambulancereports.org. Not only will we make sure you get the latest information disclosed from the Centers for Medicare & Medicaid Services, but we will also provide you with quick tutorials on how to fill out the cost data collection instrument. Most importantly, you can purchase AMBER! This software provides an easy, quick solution for you to input your data, with built-in tutorials to walk you through the data collection process.

STEP 2: Know what is included in your National Provider Identification (NPI) number.

It is important that you review the information in the Provider Enrollment, Chain, and Ownership System (PECOS) which supports the Medicare Provider and Supplier enrollment process. You will want to make sure the information that you provide in the cost data collection tool, at a minimum, matches what is in this system or on your CMS 855B Medicare enrollment application. Pay close attention to the following:

  1. Practice location(s)
  2. Vehicle Information
  3. Ownership

STEP 3: “Tele” a Friend!

More than 2,600 ambulance suppliers and providers were selected for the 2020 reporting period (Zip file download of services selected for 2020). Please reach out to your colleagues. Now is not the time to let competition or friendly rivalries stop us from communicating best practices. Call your fellow mobile healthcare providers!

STEP 4: Know your accounting “status.”

How you recognize cost and revenue will be extremely important in determining how you report. Cash accounting recognizes revenue and expenses only  when money actually exchanges hands. Accrual accounting recognizes revenue and expenses when billed, not when money exchanges hands. This status will be key in determining how you report costs and revenues.

STEP 5: Know your mileage.

For every ambulance and non-ambulance vehicle that you use related to patient care, you will need to know the odometer readings at the beginning and end of 2020. Make sure you have a system to record the odometer readings accurately.

For example, you have a 2016 ambulance where the odometer reading on 1/1/2020 is 10,212. If on 12/31/2020 the odometer reading is 74,112, you will have the option of recording the full mileage of 63,900 in the data collection tool. This is another window into the “cost of readiness.”

STEP 6: Set up and Identify payer categories.

As identified by the Medicare Ground Ambulance Data Collection System (PDF download), there are nine payer type categories for billing ambulance transportation. Know these categories and set them up in your system now, prior to billing for ambulance transports in 2020. If you use a billing agency, seek confirmation that they have a way to identify these nine payer types. You may not have select reports to identify the numbers yet within these categories but that can be set up later in the reporting year.

Setting up your system NOW to identify these payer categories is critical as it will be too administratively burdensome to fix this retroactively.

STEP 7: Know if you share support services or stand alone.

Support services are services such as maintenance, dispatch, billing, materials management, human resources and other services that support patient care. You will need to know if you share these services with other entities such as fire, police, air ambulance, hospital or other entity not related to ground ambulance care.

If you share, then you will have to work out an allocation model to assign the costs and revenue appropriately. If you do not share support services, then you do not need to work about any of the questions related to allocation.

STEP 8: Identify sources of revenue and cost categories.

Check your systems. Now is the time to make sure you can identify all sources of revenue you receive whether from billing for an ambulance transport or from a grant or local tax. Understand your costs, especially those related to salary, vehicles, facilities and medical supplies. That is the first step in the ability to categorize appropriately.

STEP 9: Don’t panic!

Take a deep breath—It is not as complicated as it may seem. There are resources available and assistance for you and your ambulance services as outlined in STEP 1.

STEP 10: Repeat Step 1!

See, that wasn’t too bad, was it? Now you have a 10 Step Plan!

In all seriousness, while it may seem a bit daunting at first, breaking down the cost data collection process into small steps will ensure that our industry is prepared and the figures we enter into this cost data collection tool will glean useful information. It is imperative that we get this right the first time to avoid any unintended consequences, such as decreased reimbursements and other impactful changes that could harm the patients we serve.

As the saying goes, “the rising tide lifts all boats.” More than ever, we need to help and assist our colleagues as we navigate this new world of ambulance reimbursement.

So, what’s next? Cost data collection, my friend! Jump on board.

2020 Stars of Life Nominations Are Open!

#StarsofLife | www.stars.ambulance.org | May 4-6, 2020 | Intercontinental Wharf | Washington, DC
The American Ambulance Association’s 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 #mobilehealthcare profession.

Nominate YOUR rockstars at www.stars.ambulance.org by March 1, 2020!