Tag: Medicare

CMS Extends Moratorium on Non-Emergency Ground Ambulance

CMS Extends Temporary Moratorium on Non-Emergency Ground Ambulance Services in New Jersey, Pennsylvania, and Texas On July 28, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a notice in the Federal Register extending the temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers in the states…

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Court Decision Overpayment Determination Statistical Sampling

Maxmed is a home health agency. In 2011, Medicare reviewed a sample of 40 claims involving 22 Medicare beneficiaries and determined that all but one were not medically necessary. The sample was extrapolated to their universe of claims, resulting in an overpayment of $773,967. The Administrative Law Judge invalidated the extrapolation methodology, but the Medicare Appeals…

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Talking Medicare: CMS Transmittal 236

On June 16, 2017, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 236. This Transmittal makes some minor changes to Chapter 10 of the Medicare Benefit Policy Manual. Specifically, CMS is clarifying its definitions related to the “ALS assessment” and “locality.” The change to the locality definition has prompted some discussion within the…

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CBO Estimates Senate Bill Would Leave 22M More Uninsured

From Akin Gump:

The Congressional Budget Office (CBO) this afternoon released its cost estimate of the Senate’s health care bill, the Better Care Reconciliation Act (BCRA), projecting that the legislation would increase the number of uninsured by 22 million in 2026 relative to the number under current law. This is slightly fewer than the number of uninsured estimated for the House-passed American Health Care Act (AHCA). CBO also estimates that the BCRA would reduce federal deficits by $321 billion over 10 years, $202 billion more than estimated net savings for the House bill.

According to the Senate Budget Committee, below is a brief summary of the changes that were made to the previous draft:

  • Conforming amendments to Sec. 106 – Changes made to better align the purposes of stability funding to the underlying CHIP statute.
  • Adds a new Sec. 206 – Starting in 2019, individuals who had a break in continuous insurance coverage for 63 days or more in the prior year will be subject to a six month waiting period before coverage begins.  Consumers will not have to pay premiums during the six month period.
  • Redesignates Secs. 206-208 to Secs. 207-209, to accommodate for the new Sec. 206 on continuous coverage.

Read the CBO report.

 

Stars of Life Recognized for Their Service

EMS professionals from all walks of life descended on the Omni Shoreham Hotel in Washington, D.C., this past week to be honored as the 2017 Stars of Life. The Stars were recognized by the American Ambulance Association (AAA) for their exceptional duty, service, and bravery while serving their communities as EMTs, paramedics, and as other ambulance services members. 107 Stars celebrated this distinction with their friends, family, and peers during the event, held June 12-14, which also shined a light on the importance of the services EMS professionals provide.

The Stars, hailing from across the country, plus Trinidad and Tobago, began their celebration with a luncheon, where their achievements were commemorated with a medal and a pin for their exceptional service. During the luncheon, keynote speaker Zubin Damania, MD, aka ZDoggMD, used humor and songs to address the future of health care and to congratulate the Stars on their award (along with garnering a few laughs) before AAA President Mark Postma presented the Stars with their medals and pins of recognition.

While Damania provided some humor and the Stars spent some time taking in the sights around the nation’s capitol, the following day provided the honorees an opportunity to head down to Capitol Hill to do some more serious work. The Stars met with members of the Senate and the House of Representatives to discuss the importance of EMS-related legislation, such as Medicare ambulance relief and add-on payments. The Stars hoped to convince Congress to support future measures that would provide critical resources and help improve EMS services. In addition to discussing important EMS policies, the Stars were honored by their representatives for their work in their community. Over 100 meetings took place between Stars, the representatives, and their aides.

The final night of the event brought all the Stars together, along with family and friends, during an awards banquet and dinner. During the event, the Stars were presented with plaques and commended for their exemplary work and for being an inspiration to all those working in the EMS field.

Learn more about the 2017 Stars of Life.

 

OIG Looking into SNF Consolidated Billing Claims

Over the past few weeks, we have been contacted by a number of ambulance suppliers that have received letters from the HHS Office of the Inspector General (OIG). These letters indicate that the OIG is conducting a national review of ambulance services that are subject to the consolidated billing provisions of the skilled nursing facility…

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CMS – MLN Ambulance Transports Booklet

CMS has issued an MLN Ambulance Transports Booklet. The booklet (36 pages) can be downloaded here. One section of the Booklet that you might want to keep handy involves Free-Standing Emergency Departments. Specifically, on page 15, CMS states the following: Freestanding Emergency Department (ED) If a freestanding ED is provider based (a department of the hospital), the ambulance…

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UnitedHealthCare Denials for ALS-2 Claims

Talking Medicare with Brian S. Werfel, AAA Medicare Consultant Over the past few weeks, we have received emails from ambulance providers across the country reporting that UnitedHealthCare (UHC) has started to deny claims for the ALS-2 base rate. Affected claims include both commercial and Medicare Advantage claims. These providers are reporting that UHC is requiring…

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Government Affairs Update: Protecting the Ambulance Add-ons

Medicare Ambulance Relief and Reform The top legislative priority this year for the American Ambulance Association is to extend, or hopefully make permanent, the temporary Medicare ambulance add-on payments. The temporary increases of 2% urban, 3% rural and the super rural bonus expire at the end of this year. The 2% urban and 3% rural…

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Senate Confirms Seema Verma as CMS Administrator

On Monday, the Senate voted 55-43 to confirm the nomination of Seema Verma to be the new Administrator of the Centers for Medicare and Medicaid Services. Ms. Verma was involved in designing Indiana’s Medicaid expansion.

Ms. Verma will be working alongside HHS Secretary Price to help implement President Trump’s healthcare agenda.

Rep. Coffman Reintroduces VA Emergency Ambulance Service Bill

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.

Administration’s Proposed Rule on Marketplace Stabilization

The Centers for Medicare & Medicaid Services (CMS) has released the “Marketplace Stabilization Proposed Rule” (Proposed Rule). Overall, the rule proposes a series of modifications to the Marketplaces that align with requests made by issuers in an attempt to keep them in the Marketplaces. The background section of the Proposed Rule emphasizes the concerns of…

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CMS Extends Temporary Moratorium (NJ, PA, TX)

On January 9, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a notice in the Federal Register extending the temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers in the states of New Jersey, Pennsylvania, and Texas. The extended moratoria will run through July 29, 2017….

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AAA Releases 2017 Medicare Rate Calculator

AAA 2017 Medicare Rate Calculator Now Available! The American Ambulance Association is pleased to announce the release of its 2017 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,…

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Rep. Tom Price Selected as HHS Secretary, Verma for CMS Admin

Rep. Tom Price, M.D., Named HHS Secretary

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President-Elect Trump has nominated Dr. Tom Price for the position of Secretary of the Department of Health and Human Services. Rep. Tom Price has served as the Congressman for the Sixth District of Georgia since 2005. He is currently the Chairman of the House Budget Committee.

Chairman Price received his B.A. and M.D. from the University of Michigan. He was first elected to Congress in 2004 and has served as on the Ways & Means committee and as Budget Committee chairman. Chairman Price opposes expanding the Affordable Care Act, voted for MACRA, supports expanded use of Health Savings Accounts, and providing age-adjusted tax credits.

Akin Gump has put together a detailed summary of legislation introduced by Rep. Price’s to repeal and replace the Affordable Care Act (H.R. 2300, the Empowering Patients First Act).

5 Things To Know About Rep. Tom Price’s Health Care Ideas

Seema Verma, Named CMS Administrator

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The President-Elect has also nominated Seema Verma for the position of CMS Administrator. Currently, she is the founder and CEO of a health policy consulting firm in Indiana. She is a close advisor to Vice President-Elect Pence and worked as a policy advisor for Governor Pence, focusing on Medicaid and public health.

Prior to consulting, Ms. Verma served as Vice President of Planning for the Health & Hospital Corporation of Marion County and as a Director with the Association of State and Territorial Health Officials (ASTHO) in Washington D.C. She received her Master’s degree in Public Health with concentration in health policy and management from Johns Hopkins University and her Bachelor’s degree in Life Sciences from the University of Maryland.

Trump Picks Seema Verma To Run Medicare And Medicaid

The AAA will keep you posted as we learn more about the plans and potential policies of Chairman Price and Ms. Verma.

CMS Announces 2017 Inflation Factor

The Centers for Medicare and Medicare Services (CMS) issued Transmittal 3625 officially announcing that the inflation factor for payments under the Medicare ambulance fee schedule for 2017 will be 0.7%. The calculation for determining the Medicare ambulance inflation factor is as follows: Consumer Price Index – Urban (which is the change in the CPI-U from…

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Prior Authorization Data Shows Dramatic Reductions in Spending on Dialysis Transports

In May 2014, CMS announced the implementation of a three-year prior authorization demonstration project for repetitive scheduled non-emergency ambulance transports.  CMS initially elected to limit this demonstration to three states: New Jersey, Pennsylvania, and South Carolina.  These states were selected based on higher-than-average utilization rates and high rates of improper payment for these services.  The…

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Prior Authorization Expansion Delay

Prior Authorization – Repetitive Non-Emergencies – Expansion Delay

CMS has notified the American Ambulance Association that the expansion of Prior Authorization for repetitive non-emergencies, to the states not already on Prior Authorization, will not be implemented January 1, 2017.

The reason for the delay is that, pursuant to Section 515(b) of the Medicare Access and CHIP Reauthorization Act (MACRA), CMS must make determinations as to whether: (1) Prior Authorization for repetitive non-emergencies saves money, (2) it adversely affects quality of care and (3) it adversely impacts access to care.

These studies are being conducted and are expected to show the program saves money without adversely affecting quality or access to care.

For those of you in states currently not under Prior Authorization, it is highly recommended that you still prepare for it to be implemented, even though it will not be implemented January 1, 2017.  You should still ensure that these patients meet the requirements for medical necessity by reviewing your documents, obtaining documents from facilities, conducting assessments of repetitive patients, implementing internal procedures and processes, etc.

For those of you in states already under Prior Authorization for repetitive non-emergencies, there is no impact.  Your program continues.

AAA Resolves Members’ Cahaba Mileage Reimbursement Issues

Many AAA members have recently reported erroneous across-the-board denial of mileage reimbursement by Cahaba. AAA board member Russell Honeycutt of Central EMS, along with several other AAA leaders, reached out to Cahaba and was able to help the carrier identify their internal process problem. Per Cahaba staff, these unjustified mileage reimbursement denials should not happen moving forward.

Ambulance services operating under Cahaba’s jurisdiction are requested to resubmit their claims electronically. Although Cahaba believes the problem is resolved, AAA encourages members to then closely monitor their Explanation of Medicare Benefits (EOMB) after resubmission to ensure that the resubmitted claims are not mistakenly denied as duplicates.

Now Available 2016 Medicare Reference Manual!

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Novitas – Denials

This advisory is for members who have Novitas as their Medicare Administrative Contractor. On August 17, 2016, Novitas called me to let me know that they are seeing many ambulance claims denied due solely to the diagnosis codes that are listed on claims. Novitas requires a minimum of two ICD-10 codes, as follows: A primary diagnosis…

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