Talking Medicare: CMS Implements Further Dialysis Cuts

Talking Medicare: CMS Implements Further Cuts in Reimbursement for Dialysis Services; Medicare Payment Data Shows Continued Reduction in Overall Spending on Dialysis Transports, but Net Increase in Dialysis Payments in Prior Authorization States On October 1, 2018, CMS implemented an additional thirteen (13%) cut in reimbursement for non-emergency BLS transports to and from dialysis. This cut in reimbursement was mandated by Section 53108 of the Bipartisan Budget Act of 2018. This on top of a ten (10%) cut in reimbursement for dialysis transports that went into effect on October 1, 2013. As a result, BLS non-emergency ambulance transports to and from dialysis that occur on or after October 1, 2018 will be reimbursed at 77% of the applicable Medicare allowable. The payment reduction is partially the result of the reduction in the amounts paid for dialysis services. However, it is also reflective of an overall decline in the number of approved dialysis transports. For this, we can look primarily to the impact of a four-year demonstration project that requires prior authorization of dialysis transports in 8 states and the District of Columbia. As a reminder, the original prior authorization states were selected based on higher-than-average utilization rates and high rates of...

This content is available only to AAA members.
Log In or Register

Talking Medicare: Prior Authorization Spending Update

Prior Authorization Data Shows Continued Reduction in Overall Spending on Dialysis Transports; Pendulum Swings Back Slightly in New Jersey and Pennsylvania In May 2014, CMS announced the implementation of a three-year prior authorization demonstration project for repetitive scheduled non-emergency ambulance transports. This demonstration project was initially limited to the states of 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. In particular, the Medicare Payment Advisory Commission (MedPAC) had singled out these states as having higher-than-average utilization of dialysis transports in a June 2013 report to Congress. Medicare payment data from calendar year 2015 showed the effect of the demonstration project. Total spending on dialysis transports was $559 million that year, down 22% from the year before.  That correlates to a cost savings to the federal government of $158 million. Telling, $137 million (86%) of those savings came from the three states that participated in the demonstration project. We now have Medicare payment data for 2016. This blog will focus on the second year of the prior authorization demonstration project. This includes tracking the effects of prior authorization on the five additional states (DE, MD,...

This content is available only to AAA members.
Log In or Register

Palmetto Announces Prior Authorization Workshops

Palmetto GBA asked AAA to share the following announcement with our members.   Repetitive Scheduled Non-Emergent Ambulance Transportation Documentation Requirements—North Carolina Palmetto GBA will hold Repetitive Scheduled Non-Emergent Ambulance Transportation Prior Authorization Demonstration face-to-face workshops in North Carolina for ambulance providers providing repetitive scheduled non-emergent transports to familiarize them with The Centers for Medicare & Medicaid Services (CMS) demonstration currently going on in South Carolina. These workshops are designed to familiarize providers, whose ambulances are garaged in potential demonstration expansion states, with demonstration requirements including the process of submitting a prior authorization request, billing for repetitive scheduled non-emergent ambulance transports under the repetitive scheduled non-emergent transportation demonstration, as well as common errors identified during the demonstration in South Carolina. Each event will include a question and answer period at the end of the formal presentation. Background Information The purpose of the current prior authorization demonstration is to ensure that beneficiaries continue to receive medically necessary care while reducing expenditures and minimizing the risk of improper payments to protect the Medicare Trust Fund by granting provisional affirmation for a service prior to submission of the claim. Prior authorization allows providers and suppliers to address issues with claims prior to rendering services (more…)