Tag: prior authorization

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

Permanent Medicare Ambulance Relief Bill Introduced in House

Moments ago, Congresswoman Terri Sewell (D-AL) and Congressman Devin Nunes (R-CA) introduced the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019 (H.R. 4938). Congressmen Peter Welch, (D-VT), Markwayne Mullin (R-OK), and Earl Blumenauer (D-OR) are original cosponsors of the legislation. Thank you to the bill sponsors for their continued support!

H.R. 4938 would help stabilize current and future Medicare reimbursement of ambulance services and set the stage for future reform of the Medicare ambulance fee schedule. If passed, this bill would:

  • Make Medicare Add-ons Permanent – Current temporary 2 percent urban, 3 percent rural, and super rural bonus payments would be made permanent.
  • Expand Prior Authorization Pilot Program Nationwide – To address fraud and abuse with the transportation of dialysis patients by ambulance, the bill expands the Centers for Medicare & Medicaid Services (CMS) national prior authorization program for repetitive non-emergency basic life support (BLS) dialysis transports. CMS has not yet exercised its authority to expand this successful pilot program nationwide. While CMS is considering exercising its authority to extend the program nationwide in a recent proposed rule, it has not made a final determination yet.
  • Provide Regulatory Relief – Amend requirements under the 855 form to make change notifications less burdensome.
  • Protect Access to Ambulance Services in Rural and Low Population Density Areas – Protect access to ambulance services in rural and super-rural areas, by establishing a policy to protect low volume areas and a process for CMS to review changes in the rural or super-rural status of an area after the next census occurs.

The AAA has worked diligently to get this legislation introduced and we are excited to share this news with the membership. We would like to thank all the AAA members who have worked closely with their elected representatives to get this legislation introduced. In the coming weeks, the AAA will be asking members to contact their Members of Congress to voice their support of this legislation.

If you have any questions, please contact Tristan North (tnorth@ambulance.org) or Aidan Camas (acamas@ambulance.org).

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…

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

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,…

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

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…

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

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…

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

Talking Medicare: GAO urges CMS to continue prior authorization

Talking Medicare: GAO urges CMS to continue prior authorization efforts On May 21, 2018, the Government Accountability Office (GAO) issued a report to the U.S. Senate Finance Committee on the use of prior authorization models by the Centers for Medicare and Medicaid Services (CMS). The GAO was asked to examine: (1) the impact of prior…

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

Update on Medicare Reimbursement Issues

The AAA would like to take this opportunity to update members on a number of issues related to Medicare reimbursement: CMS and its contractors have begun adjusting claims for ground ambulance services to reflect the restoration of the temporary add-ons. Section 50203(a) of the Bipartisan Budget Act of 2018 retroactively reinstated the temporary add-ons for…

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

First Interim Evaluation Report on Medicare Prior Authorization

Talking Medicare: First Interim Evaluation Report on Medicare Prior Authorization (An 80-page report confirming what you already likely suspected) On February 28, 2018, the Centers for Medicare and Medicaid Services (CMS) posted an interim report on its prior authorization demonstration project for repetitive, scheduled, non-emergent ambulance transportation. The report, titled First Interim Evaluation Report of…

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

Summary of December 2017 Ambulance Open Door Forum

On December 14, 2017, CMS held its latest Open Door Forum. As usual, it started with a few announcements, as follows: Ambulance Inflation Factor – CMS announced that it had published Transmittal 3893 on October 27, 2017, which sets forth the Ambulance Inflation Factor (AIF) for calendar year 2018. In that Transmittal, CMS indicated that…

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

CMS Extends Prior Authorization for 2018

CMS Announces Extension of Prior Authorization for Repetitive Non-Emergency Ground Ambulance Transports

On December 4, 2017, CMS posted a notice on its website indicating that it would be extending the prior authorization demonstration project for another year. The extension is limited to those areas where prior authorization was in effect for calendar year 2017. 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, 2018.

Read the Full CMS Notice

In its notice, CMS indicated that claims with dates of service between December 2 and December 4, 2017 would not be subject to prior authorization or prepayment review, but that ambulance providers could elect to submit a request for prior authorization for these transports. All repetitive non-emergency transports on or after December 5, 2017 would require prior authorization.

Navigating a Post-Prior Authorization World

Talking Medicare: Navigating a Post-Prior Authorization World Novitas Solutions, Inc. recently announced that it will no longer issue prior authorizations for scheduled, repetitive non-emergency transports, effective December 1, 2017. This announcement was based on Novitas’ expectation that the demonstration project will expire at the end of this calendar year. For ambulance suppliers in the states…

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…

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

The Future of Prior Authorization

In May 2014, CMS announced the creation of a three-year demonstration project that calls for the prior authorization of repetitive scheduled non-emergency ambulance transports. The demonstration project was first implemented in the states of New Jersey, Pennsylvania, and South Carolina. These states were selected based on their higher-than-average utilization rates for repetitive ground ambulance transportation….

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

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…

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

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.

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 and to avoid the appeal process.

Prior authorization will not create new clinical documentation requirements. Instead, it will require the same information necessary to support Medicare payment, just earlier in the process.

Workshop Topics:

  • Repetitive Scheduled Non-Emergent Ambulance Transportation Demonstration Expansion Regulations
  • Documentation Requirements
  • Proper Claim Submission
  • Q & A

Note:

  • These workshops will provide insight for new, intermediate or advanced staff; however, we suggest that providers who are new to Medicare or have new staff attend online learning courses for beginners on the Palmetto GBA website. Basic billing and other online educational resources can be found in the Self-Paced Learning section under the Learning and Education link on the left navigation.
  • CMS requires that Medicare contractors track all educational activities, which consists of capturing the provider’s six-digit Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI). Please bring this information when attending the workshop.

North Carolina
Ambulance Prior Authorization Workshop: Repetitive Scheduled Non-Emergent Ambulance Transports
Audience: Part B Ambulance providers of repetitive scheduled non-emergent ambulance transports
Event Type: In Person Seminar


How to Register

The schedule of workshops and registration information is listed below. To reserve your seat or find out more about the workshops in your area, please make sure you:

  1. Create a profile at the new Event Registration Portal to create an account. Your existing Workshops database profile is not linked to the new portal as the profile creation process is different.
  2. Log in your Event Registration Portal account and you will be able to register yourself or other people for any workshops hosted in the portal before registration closes. Each workshop will have a separate registration link. For the workshops that Palmetto GBA sponsors, Palmetto GBA’s registration page will be displayed. If the state Association is sponsoring the workshop, the link will take you directly to the Association’s registration page.

**As a reminder, providers are encouraged to telephone the Provider Contact Center (PCC) at 855-696-0705 with any claim specific questions they may have as these will not be able to be addressed at the workshop.

Summary of CMS Ambulance Open Door Forum of November 5, 2015

By David M. Werfel, Esq. | Updated November 6, 2015 On November 5, 2015, the Centers for Medicare and Medicaid Services (CMS) conducted its latest Ambulance Open Door Forum.  As usual, CMS started with announcements, which were as follows: As required under the Medicare Access and CHIP Reauthorization Act (HR 2), the pilot program for…

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

Prior Auth Expansion to MD, DE, DC, NC, VA, WV

CMS Announces Expansion of Prior Authorization Program for Repetitive Scheduled Non-Emergent Ambulance Transports October 26, 2015 CMS has announced that consistent with the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), it will expand the current prior authorization demonstration program for repetitive scheduled non-emergent ambulance transports beginning on January 1, 2016,…

This content is available only to AAA members.
Log In or Register
  • 1
  • 2