On November 28, 2018, CMS posted the 2019 Ambulance Fee Schedule Public Use Files. These files contain the amounts that will be allowed by Medicare in calendar year 2019 for the various levels of ambulance service and mileage. These allowables reflect a 2.3% inflation adjustment over the 2018 rates.
The 2019 Ambulance Fee Schedule Public Use File can be downloaded from the CMS website by clicking here.
Unfortunately, CMS has elected in recent years to release its Public Use Files without state and payment locality headings. As a result, in order to look up the rates in your service area, you would need to know the CMS contract number assigned to your state. This is not something the typical ambulance service would necessarily have on hand. For this reason, the AAA. has created a reformatted version of the CMS Medicare Ambulance Fee Schedule, which includes the state and payment locality headings. Members can access this reformatted fee schedule here.
The Centers for Medicare and Medicaid Services (CMS) issued a notice regarding the extension of Medicare provider provisions included in the Bipartisan Budget Act. The notice includes a paragraph with the details of the extension of the ambulance add-ons. The notice also states that “Medicare Administrative Contractors (MAC) will implement these changes no later than February 26, 2018 and will provide additional details on timelines for reprocessing or release of held claims impacted by these changes.” As previously reported by the AAA, on February 14, CMS posted a revised Public Use File with the new Medicare ambulance fee schedule rates which include the 2% urban, 3% rural and super rural increases. We will keep you posted about any new developments about the reprocessing of previously submitted claims.
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On December 14, 2017, CMS held its latest Open Door Forum. As usual, it started with a few announcements, as follows:
As with previous forums, CMS then fielded questions from the audience. The majority of these questions focused on the prior authorization process. As with previous ODFs, CMS declined to answer most of the questions on the call, instead asking the provider to submit their questions to CMS via email.
CMS did answer the following questions on the call:
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On June 1, 2015, CMS publicly released the “Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File”, which provides information on the services and procedures provided to Medicare beneficiaries by ambulance suppliers, physicians and other healthcare provider groups. The data file is based on calendar year 2013 data. This release follows on last year’s release of payment data for calendar year 2012.
The database lists all individual and organizations providers by National Provider Identifier (NPI), and provides information on utilization, total payments and submitted charges. It can also be searched by Healthcare Common Procedure Coding System (HCPCS) code and place of service.
The Public Use File can be obtained by clicking here: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html. Please note that you will need to download the desired file and then import it into an appropriate database or statistical software program. CMS is indicating that Microsoft Excel is not sufficient for these purposes, and that importing it into Excel may result in an incomplete loading of data.
A number of news organizations have already created searchable databases that will allow you to search the 2012 data by physician/organizational name, provider specialty, city, state, etc. It is expected that these news organizations will be updating their websites to incorporate the 2013 data in the coming weeks. The searchable database created by the Wall Street Journal can be accessed by clicking here: http://projects.wsj.com/medicarebilling/?mod=medicarein.