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 ground ambulance services. These add-ons increase the applicable Medicare allowables by 2% in urban areas, 3% in rural areas, and 22.6% in “super rural” areas (over and above the corresponding rural rate), retroactive to January 1, 2018. On a March 7, 2018 Open Door Forum, CMS indicated that it had updated the Medicare Ambulance fee schedule to reflect these higher rates, and that it has provided a Change Request to each of its Medicare Administrative Contractors (MACs). The AAA has confirmed that all MACs have successfully implemented the new rates, and that all are paying current claims at the correct rate. The AAA has further confirmed that MACs have started to adjust 2018 claims paid at the original (lower) rates. Unfortunately, neither CMS nor its MACs have committed to a firm timetable for the completion of all required adjustments; however, a number of MACs have...

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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 the CY 2018 AIF would be 1.1%. This is based on an increase in the CPI-U of 1.6%, and a multi-factor productivity adjustment of 0.5%. Expiration of Temporary Adjustments – CMS indicated that the current temporary adjustments for urban (2%), rural (3%) and super rural ground ambulance transports are set to expire on December 31, 2017. CMS also indicated that they were aware of proposed legislation that would extend these adjustments for 2018 and beyond, but that they have yet to be enacted into law. CY 2018 Public Use File – CMS indicated that the Public Use File on its website has been updated to include Medicare allowables for 2018. CMS made a point of noting that the 2018 rates do not include the temporary adjustments, as they are set to expire on December 31, 2017. Prior Authorization Demonstration Project – CMS indicated that it...

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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. 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 that currently operate under prior authorization, the focus invariably turns to what that means for their repetitive patient populations? First a little background. 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. As initially conceived, the prior authorization demonstration project first went into effect on December 15, 2014. Congress subsequently elected to expand this demonstration project to additional states as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Specifically,...

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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 (more…)

Spotlight: Tristan North

  Tristan North Vice President of Government Affairs, AMG Senior Vice President of Government Affairs, AAA McLean, VA Tell us a little about yourself, please. I grew up in the suburbs of Washington, DC and went to Langley High School near the CIA headquarters. I attended Babson College outside of Boston where I received my B.S. in Finance. During college I played rugby and was a member of the Tau Kappa Epsilon fraternity. Between junior and senior years of college, I worked in the Document Room of the U.S. House of Representatives. Following college, I landed an internship with the Committee on Financial Services of the U.S. House of Representatives. I started in the press office but ultimately became a professional staff member with the investigation team. I worked on a number of issues during my tenure including currency anti-counterfeiting, credit unions and the solvency of the banking system. After Capitol Hill I joined the Government Affairs Section of the PR firm, Fleishman-Hillard. I expanded my portfolio to include health care issues and became part of the lobbying team for the American Ambulance Association. The AAA then hired me internally as their first Director of Government Affairs and the rest (more…)