Submit Comments to Address High MA Ambulance Copays!
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Tag: Centers for Medicare and Medicaid Services (CMS)
CMS Announces FY 2026 Rural Health Transformation Awards
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AAA Ground Ambulance Data Collection Webinar and Payment Reform Update
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CMS Posts 2026 Public Use File
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CMS Releases New GADCS Report
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CMS Published a MLN Matters Article on the Reprocessing of Claims
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CMS Announces CY 2026 Ambulance Inflation Factor
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CMS Lifts Ambulance Claims Hold
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Medicare Claims Hold Clarification
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Billing Considerations for Ambulance Providers as Federal Government Shutdown Approaches End of Second Week
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Congressional Letter on Updating Medicare Zip Codes
On September 18, Congresswoman Carol Miller (R-WV) was joined by 13 members of Congress in a letter to CMS requesting that the agency update the zip code designations under the Medicare ambulance fee schedule based on the 2020 census.
According to an analysis by AAA data firm of Health Management Associates, the update would result in a net of 1,490 zip codes being redesigned as super rural instead of rural and 782 zip codes being rural instead of urban. Ground ambulance service organizations that serve these rural and super rural areas would thus benefit from the additional reimbursement for rural and super rural areas.
CMS is overdue in automatically updating the zip codes based on the 2020 census data.
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CMS Announces New Proposed ABN Form
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AAA Letter to CMS- Reducing Regulatory Burdens on Ground Ambulance Providers
On June 9, the AAA submitted to CMS a letter on ways the Administration can reduce regulatory burdens on ground ambulance service organizations. The AAA requested that CMS eliminate the requirement to obtain a Physician Certification Statement (PCS), remove the vehicle section from the 855 form and eliminate the patient signature requirement. The letter was in response to a request for information (RFI) issued by CMS.
Amber Ground Ambulance Dataset Reflects Complexity and Challenges of the Industry, Highlights the Need to Improve and Continue Cost Data Collection
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AAA Releases 2025 Medicare Rate Calculator
On December 23, 2024, CMS posted a revised version of the CY 2025 Ambulance Fee Schedule Public Use Files on its website. These files contain the Medicare allowed amounts for the various levels of ambulance service and mileage. The file is organized by state, and by payment locality within each state. The 2025 Ambulance Fee Schedule Public Use File can be viewed 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. Members can access this reformatted fee schedule below.
The American Ambulance Association is also pleased to announce the release of its 2025 Medicare Rate Calculator tool. The AAA believes this is a valuable tool that can assist members in budgeting for the current year. This calculator has been updated to account for recent changes in Medicare policies, including the 2025 Ambulance Inflation Factor and the extension of the temporary adjustments for ground ambulance services (i.e., 2% urban, 3% rural, and super rural bonus) through March 31, 2025. This extension was the result of Section 3203 of the American Relief Act, 2025. Barring further legislation, these temporary adjustments will expire on March 31, 2025.
Note on Medicare Sequestration: Both the Ambulance Fee Schedule Public Use Files and the AAA Medicare Rate Calculator display the current Medicare allowables. Neither takes into account the impact of so-called “budget sequestration” on Medicare payments. By law, the sequester requires Medicare contractors (and Medicare Advantage insurers) to reduce the amounts they pay under the Medicare Ambulance Fee Schedule by 2% (i.e., 2% off the 80% of the Medicare allowable typically paid by the Medicare contractor).
CMS Posts Revised 2025 Public Use File
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CMS Notifies Individuals Potentially Impacted by WPS Data Breach
On September 6, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that CMS and its contractor, Wisconsin Physician Service Insurance Corporation (WPS), have begun the process of notifying nearly a million Medicare beneficiaries that were potentially impacted by a data breach involving WPS.
The data breach involved WPS’ use of the third-party application MOVEit. MOVEit is a file transfer application developed by Progress Software. In May 2023, a hacker group called CL0P discovered a security vulnerability that allowed the company to steal sensitive information from secure databases used by numerous governmental agencies and corporations. This included the protected health information (PHI) of Medicare beneficiaries and non-Medicare beneficiaries stored within WPS’ databases.
The notices inform affected Medicare beneficiaries of the steps they can take to protect themselves. As part of its remedial efforts, WPS is offering affected Medicare beneficiaries one year of free credit monitoring from Experian.
CMS indicated that it was not aware of any reported incidents of fraud or improper use of a Medicare Beneficiary Identifier (MBI). However, CMS noted that, if the beneficiary’s MBI was potentially impacted, they would mail a new Medicare card with a new MBI to the patient. Thus, the data breach has the potential to impact the patient demographic information you currently maintain within your billing systems. This is especially true for AAA Members that operate in Medicare jurisdictions currently administered by WPS (Iowa, Indiana, Kansas, Michigan, Missouri, and Nebraska). Specifically, the MBIs on file for existing patients may no longer be accurate. This also has the potential to impact Medicare eligibility information that you receive from other parties like hospitals, skilled nursing facilities, etc.
AAA Members will have to make a business judgment on how to address these potential concerns. One possible option would be to implement a process to confirm the MBI of existing patients prior to the submission of new claims. Another possible option might be to implement internal procedures to flag claims that are denied for an incorrect MBI as potentially related to this issue, and to then verify the patient’s correct MBI prior to resubmitting any denied claims.
CMS Schedules ODF for August 1, 2024 | CY 2025 PFS
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CMS GADCS: Labor Costs Webinar Recording
CMS recently posted an updated Medicare Ground Ambulance Data Collection System (GADCS) webinar on Labor Costs on their Ambulance Events webpage.
CMS Begins Notifications to Ground Ambulance Providers that Failed to Submit Cost Data
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