The American Ambulance Association has been working hard to accomplish the legislative goals of the membership in the 116th Congress. The AAA would like to take this opportunity to provide an update on what we have accomplished thus far in the 116th Congress. Balance/Surprise Billing Balance/surprise billing is a hot button issue that recently came into the spotlight at the start of the 116th Congress. With the President’s announcement calling for Congress to pass legislation that would end surprise billing for patients, there has been an increase in Congressional action on the issue including introduced legislation, discussion drafts and hearings in all committees of jurisdiction. The AAA has been working tirelessly with the Congressional committees of jurisdiction to educate Members and staff on the unique characteristics of EMS systems and that it would be inappropriate to apply the same restrictions on balanced billing to ground ambulance services. The AAA has formed a working group comprised of AAA member volunteers that have worked on policy and messaging on balance billing. The working group has submitted comments to the Energy and Commerce Committee and Senate HELP committees advocating that the ambulance industry is unique from other stakeholders, and as such, should be looked (more…)
On April 1, 2019, CMS implemented a new series of Common Working File (CWF) edits that are intended to better identify ground ambulance transports that are furnished in connection with an outpatient hospital service that is properly bundled to the skilled nursing facility (SNF) under the SNF Consolidated Billing regime. These edits work by comparing the ambulance claim to the associated outpatient hospital claim. Hospital claims were already subject to CWF edits designed to identify outpatient hospital services that should be bundled to the SNF. These hospital edits operate by referencing a list of Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes that correspond to outpatient hospital services that are expressly excluded from SNF Consolidated Billing. Hospital claims for outpatient services that are submitted with one of these excluded codes bypass the existing CWF edits, and are then sent to the appropriate Medicare Administrative Contractor for further editing and payment. Hospital claims submitted without one of these codes are denied for SNF Consolidated Billing. The new ambulance edits will extend these process one step further. The ambulance claim will be associated with the outpatient hospital claim on the same date. To the extent that hospital claim...
The Senate voted today to confirm Robert Wilkie as Department of Veterans Affairs secretary. Wilkie, previously an undersecretary at the Pentagon, was approved by the Senate 86-9. Of note, Wilkie becomes the fourth VA Secretary in the past five years. New VA Secretary, Robert Wilkie Senate confirms Robert Wilkie to be the next VA Secretary What To Know About Trump’s VA Secretary Nominee Robert Wilkie Wilkie takes over after Secretary David Shulkin was fired earlier this year. Wilkie is the second nominee put forward to replace Shulkin after White House physician, Ronny Jackson, withdrew his nomination in April.
Veterans Administration Issues Interim Final Rule Expanding Coverage of Ambulance Services under Millennium Bill On January 9, 2018, the Department of Veterans Affairs issued an interim final rule that would amend its policy for payment of Millennium Bill claims. The Millennium Bill authorizes the Veterans Administration (VA) to pay for emergency care provided to veterans in non-VA facilities — including emergency ambulance transportation — provided the veteran has no other health insurance that would cover the costs of such emergency care. These changes were necessitated, in part, by a recent decision of the U.S. Court of Appeals for Veterans’ Appeals (Staab v. McDonald, 28 Vet. App. 50, 2016). The two major changes being made by the interim final rule are: (1) the expansion of payment eligibility to include veterans who received partial payment or reimbursement from a health plan for their non-VA emergency care and (2) the expansion of payment eligibility for emergency transportation associated with a veteran’s receipt of emergency treatment in a non-VA facility. These changes went into effect on January 9, 2018. Relevant Background 38 U.S.C. §1725 authorizes the VA to reimburse veterans for the costs of emergency treatment for non-service connected conditions furnished in a non-VA (more…)
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.
The House VA Committee hearing started at 7:30 p.m., but it was well-attended and lasted until 10 p.m. The witnesses included Senator John McCain (R-AZ), VA Secretary David Shulkin, and representatives of the VA Office of Inspector General and the Government Accountability Office. Senator McCain and Secretary Shulkin were both warmly welcomed by Members of the Committee on a bipartisan basis. Chairman Roe (R-TN) emphasized the need to act quickly to extend the authorization for the Veterans Choice Program, which expires on August 7. To that end, the House VA Committee is voting today on a bill to eliminate the sunset of the program’s authorization. In addition, the Committee will consider broader legislation later this year to make comprehensive reforms to the Choice Program. He noted that the VA has additional funds available but will not be able to spend them once the authorization expires. A copy of Chairman Roe’s opening statement is available here. Secretary Shulkin testified in support of extending the Choice Program, and he clarified that the VA was not seeking additional funding – just the authority to spend funds already obligated. He noted that the VA already is being forced to deny Choice Program coverage to...
The Senate voted Monday to confirm David Shulkin as Department of Veterans Affairs secretary. Shulkin, previously the undersecretary at the Department of Veterans Affairs was unanimously approved by the Senate 100-0. Of note, Shulkin becomes the first VA Secretary to have not previously served in the military. New VA Secretary, David Shulkin Everything you need to know about new VA Secretary David Shulkin Senate Confirms First Nonveteran To Lead VA A physician, Shulkin previously administered hospital systems such as Beth Israel Hospital in New York, before coming to the VA. During his hearing, Shulkin “promised veterans organizations that he opposes privatization of the VA.” Shulkin will continue to work towards lowering wait times for veterans and implementing the Veterans Access Choice and Accountability Act.
Asbel Montes, AAA Payment Reform Committee co-chair and all-around reimbursement expert, recently developed some great quick tips on billing the US Department of Veterans Affairs for ambulance services. Do you have a process in place to identify when a transported individual is a veteran being carried to a non-VA facility? In an emergency condition, it may prove very beneficial for you to have a consistent process within your billing department to ensure that you can identify these patients in order to maximize reimbursement, while also avoid billing the patient inappropriately… READ MORE► Read Asbel’s full article over on www.reimbursementanswers.com, or learn more in person at the upcoming June 9 AAA Regional Workshop in the San Francisco area!