Medicaid billing in emergency medical services is unavoidable. From trauma trips to non-emergency transports, ambulance providers face a multitude of hurdles when trying to identify, verify and bill the correct payor for Medicaid patients. Guesswork is often used instead of real-time insurance verification. This can be especially true when commercial payors such as United Healthcare and Blue Cross Blue Shield manage the Medicaid plan, commonly termed Medicaid Replacement Plans. This article provides four valuable tips for successfully processing EMS claims when a Medicaid Replacement Plan is involved. The Challenge for EMS Billing: Benefits Verification Just as commercial payers see growth opportunities in managing Medicare Advantage (MA) plans, they are also overseeing hundreds of Medicaid programs. According to the annual CMS-64 Medicaid expenditure report, in federal fiscal year (FFY) 2016, Medicaid expenditures across all 50 states and 6 territories exceeded $548 billion, with nearly half of all spending now flowing through Medicaid managed care programs. On average 54.67% of Medicaid dollars are spent on managed care, whether to manage the transition or fund plans. This ranged from 97.9% in Puerto Rico, down to 12.1% in Colorado. A single trip may have Medicaid benefits, but also managed by United Healthcare or another (more…)
Governor Kay Ivey recently signed into law Alabama’s REPLICA legislation, HB250. Alabama joins ten other states—Colorado, Texas, Virginia, Idaho, Kansas, Tennessee, Utah, Wyoming, Mississippi, and Georgia—in this forward-thinking interstate compact. REPLICA, the Recognition of EMS Personnel Licensure Interstate Compact, recognizes the day-to-day movement of EMS personnel across state lines. It extends the privilege to practice under authorized circumstances to EMS personnel based on their home state license, as well as allows for the rapid exchange of licensure history between Compact member states.. Learn more about how REPLICA participation can help your state at http://www.emsreplica.org.
REPLICA Meets Goal, Interstate Compact Becomes Official May 8, 2017 For Immediate Release Contact: Sue Prentiss 603-381-9195 email@example.com May 8, 2017 (Falls Church, VA). With the 10th member state enactment, the Recognition of Emergency Medical Services Licensure Interstate Compact (REPLICA) has become official. Governor Nathan Deal of Georgia signed Senate Bill 109 on today activating the nation’s first EMS licensure compact. States that have passed REPLICA to date include: Colorado, Texas, Kansas, Virginia, Tennessee, Idaho, Utah, Mississippi, Wyoming and Georgia. Released in 2014, REPLICA’s model legislation creates a formal pathway for the licensed individual to provide pre-hospital care across state lines under authorized circumstances. According to Keith Wages, president of the National Association of State EMS Officials (NASEMSO), “REPLICA represents a collective, nationwide effort to address the problems faced by responders when needing to cross state borders in the line of their duties.” Wages highlighted the compact’s abilities to “increase access to healthcare, reduce regulatory barriers for EMS responders, and place an umbrella of quality over cross border practice not previously seen in the EMS profession.” Wages also noted that the partnership with the National Registry of Emergency Medical Technicians (NREMT) has been essential during the advocacy and implementation phases. (more…)
Congressman Mike Coffman to Receive 2017 AAA Legislative Recognition Award For Immediate Release Contact: Amanda Riordan firstname.lastname@example.org 703-610-0264 Washington, DC– The American Ambulance Association (AAA) will honor Congressman Mike Coffman of Colorado with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services. Congressman Coffman will be presented this award in June in Washington, DC by AAA’s Colorado Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Boulder State are Kira Gressman of American Medical Response, as well as Gabe Moreno of Trinidad Ambulance District. Congressman Coffman was selected for the Legislative Recognition Award for introducing the Veterans Reimbursement for Emergency Ambulance Services Act (H.R. 1445). AAA members are deeply appreciative of his championing efforts to ensure that ambulance services are properly reimbursed for providing emergency medical services to veterans. AAA President Mark Postma notes, “Congressman Coffman has been a trusted advocate for health care and emergency medical services, both in Colorado and across our country. The AAA is proud to present him with a Legislative Recognition Award.” Elected to the U.S. House of Representatives in 2008 from Colorado’s 6th congressional district, Congressman Coffman serves on the Veteran’s Affairs Committee and (more…)
The American Ambulance Association is proud to announce the winners of the 2017 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing service to the ambulance services of the United States. 2017 AAA Legislator of the Year Senator Susan Collins (R-ME) – Press Release, Facebook Post, Twitter Post 2017 AAA Legislative Recognition Award Recipients Senators Sen. Richard Burr (R-NC) – Press Release Sen. Bill Cassidy (R-LA) – Press Release Sen. Orrin Hatch (R-UT) – Press Release Sen. Patrick Leahy (D-VT) – Press Release Sen. Pat Roberts (R-KS) – Press Release Sen. Charles Schumer (D-NY) – Press Release Sen. Debbie Stabenow (D-MI) – Press Release Sen. Jon Tester (D-MT) Sen. Ron Wyden (D-OR) – Press Release Representatives Rep. Kevin Brady (R-TX) – Press Release Rep. Mike Coffman (R-CO) – Press Release Rep. Gregg Harper (R-MS) Rep. Richard Hudson (R-NC) – Press Release Rep. Kenny Marchant (R-TX) Rep. Markwayne Mullin (R-OK) Rep. Richard Neal (D-MA) Rep. Devin Nunes (R-CA) – Press Release Rep. Erik Paulsen (R-MN) Rep. Peter Roskam (R-IL) – Press Release Rep. Mike Thompson (D-CA) Rep. Pat Tiberi (R-OH) – Press Release Rep. Fred Upton (R-MI) Rep. Greg Walden (R-OR) Rep. Peter Welch (D-VT)...
Today, citing “growing pains” of his Republican majority, Speaker Paul Ryan (R-WI), in consultation with President Donald Trump, determined not to proceed with a planned vote on the American Health Care Act (AHCA), which repealed and replaced important elements of the Affordable Care Act (ACA). The Speaker indicated that the House Republican Caucus “came up short” in the number of votes needed for the bill. House Republican Leadership had been moving AHCA through the Chamber at a rapid pace. The bill was officially released on March 6, and had been changed several times to try to appease various conservative and moderate voting blocs within the Republican Caucus. The Congressional Budget Office (CBO) originally estimated the bill would reduce federal deficits by $337 billion, and subsequently downgraded the deficit reduction to $150 billion based on additional substantive policy changes to the bill. The CBO estimates the bill would have increased the country’s number of uninsured by about 24 million people. In negotiating the provisions of AHCA, the House Republican Leadership had faced a constant seesaw, as efforts to appease one ideological bloc upset the other. Ultimately, throughout the day in advance of the scheduled vote, an increasing number of moderate Republicans,...
On March 9, 2017, Rep. Mike Coffman [R-CO-6] reintroduced the Veterans Reimbursement for Emergency Ambulance Services Act (H.R. 1445). The VREASA (Veterans Reimbursement for Emergency Ambulance Services Act) would provide veterans with reimbursement for emergency ambulance services when a Prudent Layperson would have a reasonable expectation that a delay in seeking immediate medical attention will jeopardize the life or health of the veteran. Currently, prior to reimbursement, the Department of Veterans Affairs (VA) requires all medical records be provided, including the records of treatment after the emergency service has taken place. Should those records show that it was not a life threatening emergency or a false alarm, the claim for reimbursement is denied. The veteran is stuck with the bill. Medicare, Medicaid, and other major payers adhere to the “prudent layperson” standard for the reimbursement of emergency ambulance services. The VA is the only major payer to not follow this standard. It is time we ensure our veterans are not stuck with the bill for their emergency ambulance service. AAA Member, American Medical Response and their VP Federal Reimbursement & Regulatory Affairs, Deb Gault, have been working with Rep. Coffman’s office to get this bill reintroduced.
On March 4, Novitas Solutions, Medicare Administrative Contract managers for several jurisdictions, asked AAA to share the following information with ambulance services. March 4, 2016 – Letter to Ambulance Providers | March 4, 2016 – Letter to Beneficiaries Jurisdictions Covered By Novitas The Medicare Administrative Contract (MAC) Jurisdiction L (JL), which spans Pennsylvania, New Jersey, Maryland, Delaware and Washington D.C.; The Medicare Administrative Contract (MAC) Jurisdiction H (JH), which spans Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, Mississippi, Indian Health Service (IHS) and Veterans Affairs (VA); and The payment processing for the Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract, as authorized under Section 1011 of the 2003 Medicare Modernization Act.