CMS “Pauses” Prior Authorization Model for Scheduled, Repetitive Non-Emergency Ambulance Transportation

CMS released published a guidance document summarizing some of the steps that it has taken to relieve the administrative burden on health care providers and suppliers during the current public health emergency.  As part of that document, CMS indicated that it will be “pausing” the Prior Authorization Model for scheduled, repetitive non-emergency ambulance transports.  Under this program, ambulance suppliers are required to seek and obtain prior authorization for the transportation of repetitive patients beyond the third round-trip in a 30-day period.  Absent prior authorization, claims will be stopped for pre-payment review.  The Prior Authorization Model is currently in place in Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, West Virginia, and the District of Columbia. CMS indicated that this pause went into effect as of March 29, 2020, and will continue for as long as the current public health emergency continues.  During this pause, claims for repetitive, scheduled, non-emergency transports will not be stopped for pre-payment review if the prior authorization has not been requested and obtained prior to the fourth round-trip.  However, CMS indicated that claims submitted and paid during the pause without prior authorization will be subject to postpayment review. CMS further indicated that during this...

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40 Under 40: Alan Brook (New Hanover Regional Medical Center – Wilmington, NC)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession. ____ Alan Brook Lieutenant / Field Training Officer New Hanover Regional Medical Center Wilmington, NC ____ LinkedIn | Twitter Nominated by: Benjamin Calhoun (New Hanover Regional Medical Center – Wilmington, NC) ____ Biography: Alan Brook has been a Paramedic in the Southeastern North Carolina region for 13 years. Alan currently serves as a Field Training Officer for New Hanover Regional Medical Center’s EMS division, which has recently ranked as the best EMS services in the nation by EMS World. When Alan isn’t providing patient care, he can frequently be found at the local community college, where he serves as a part time instructor for the paramedic program. In his free time, Alan enjoys an active lifestyle and often competes in half marathons, scuba diving, and Olympic weight lifting. ____ Reason for Nomination: Alan developed a passion for “taking care of his own” after a coworker committed suicide. In 2014, Alan focused on the well-being of his peers, and went to training for Critical Incident Stress Management. Alan has since taken part in (and (more…)

40 Under 40: Joshua Holloman (Johnston County Emergency Services – Clayton, NC)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession. ____ Joshua Holloman Deputy Director Johnston County Emergency Services Clayton, NC ____ LinkedIn | Twitter Nominated by: Emily Johnson (Johnston County Emergency Services – Smithfield, NC) ____ Biography: Joshua B. Holloman, MHS, NRP, CEMSO, is the Deputy Director of Johnston County Emergency Services in North Carolina. Josh is a certified paramedic, firefighter, and Emergency Medical Dispatch instructor. Josh is an advocate for increasing education, professionalism, and leadership within emergency services. Josh obtained an associate of applied science degree in EMS from Wake Technical Community College in Raleigh, N.C. and attended Western Carolina University, obtaining a Bachelor of Science and a Master of Health Sciences degree. Holloman has served Johnston County in positions including Cadet, EMT, Paramedic, Training Officer, and Division Chief, prior to becoming Deputy Director for the Emergency Services Department. ____ Reason for Nomination: Josh Holloman is a constant professional who deserves to be recognized as an inaugural recipient of the Mobile Healthcare 40 under 40. Josh has played a significant role in the development of the local EMS system in Johnston (more…)

CMS Announces Comment Period for National Expansion of Prior Authorization Process

On October 29, 2019, the Centers for Medicare and Medicaid Services (CMS) posted a notice in the Federal Register announcing an opportunity for the public to provide comments on the proposed national expansion of the prior authorization process for repetitive, scheduled non-emergent ground ambulance transportation.  CMS refers to this process as its “RSNAT Prior Authorization Model.”  The CMS Notice can be viewed in its entirety at: https://www.govinfo.gov/content/pkg/FR-2019-10-29/pdf/2019-23584.pdf. Under the Paperwork Reduction Act of 1995, federal agencies are required to publish a notice in the Federal Register concerning each proposed collection of information, and to allow 60 days for the public to comment on the proposed action.  Interested parties are encouraged to provide comments regarding the agency’s burden estimates and other aspects of the proposed collection of information, including the necessity and utility of the proposed information for the proper performance of the agency’s functions, and ways in which the collection of such information can be enhanced. In this instance, CMS is indicating that it is pursuing approval to potentially expand the existing RSNAT Prior Authorization Model nationwide.  Currently, the RSNAT Prior Authorization Model is in place in 8 states (DE, MD, NJ, NC, PA, SC, VA, and WV) and the...

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2019 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2019 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize  mobile healthcare. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation, and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on November 5 in Nashville. Please join us in congratulating our 2019 winners! Clinical Outcome Program Medic Ambulance Service Inc. CPR Initiative Community Impact Program Advanced Medical Transport CPR Race to the Top American Medical Response (Manchester/Nashua, NH) Safe Station Project Sunstar Paramedics Health & Safety Fair Employee Programs American Medical Response (Buffalo, NY) Recruitment/Training Program Northstar EMS, Inc Medical Director Engagement Through Technology Public Relations Campaign Acadian Ambulance Service Hometown Hero Initiative Mecklenburg EMS Agency Bystander CPR Initiative With Pulsepoint Once again, join us in celebrating the 2019 winners! Learn more about the AMBYs.

CMS Announces Extension of Prior Authorization Program

On September 16, 2019, CMS published a notice in the Federal Register that it would be extending the prior authorization demonstration project for another year. The extension is limited to those states where prior authorization was in effect for calendar year 2019. The affected states are Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia, as well as the District of Columbia. The extension will run through December 1, 2020.  In its notice, CMS indicated that the prior authorization demonstration project is being extended “while we continue to work towards nationwide expansion.”  This strongly suggests that CMS believes the program has met the statutory requirements for nationwide expansion under the Medicare Access and CHIP Reauthorization Act of 2015.  However, CMS indicated that it would use the additional year to continue to test whether prior authorization helps reduce expenditures, while maintaining or improving the quality of care offered to Medicare beneficiaries. CMS has also updated its CMS Ambulance Prior Authorization webpage to reflect the expansion of prior authorization in the existing states through December 1, 2020....

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CMS Announces Extension of Prior Authorization Program

On November 30, 2018, CMS issued a notice on its website that it would be extending the prior authorization demonstration project for another year. The extension is limited to those states where prior authorization was in effect for calendar year 2018. The affected states are Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia, as well as the District of Columbia. The extension will run through December 1, 2019.  CMS indicated that the extension will provide it with an additional year to evaluate the prior authorization program, and to determine whether the program meets the statutory requirements for nationwide expansion under the Medicare Access and CHIP Reauthorization Act of 2015. CMS has also updated its Ambulance Prior Authorization FAQs and its Physician/Practitioner Letter to reflect the expansion of the program. The updated FAQ and Physician Letter can be downloaded from the CMS Ambulance Prior Authorization webpage by clicking here....

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