Tag Archives: ambulance services

CMS Announces New 6-Month Extension of Moratoria on Enrollment of HHAs, Ambulance Suppliers in Designated Areas

CMS is extending — for another 6 months — its current enrollment moratoria for new ground ambulance suppliers and home health agencies (HHAs) in designated metropolitan areas. The moratoria, which affect enrollment in Medicare, Medicaid, and the Children’s Health Insurance Program, apply to new ground ambulances in the Houston and Philadelphia metropolitan areas and new HHAs … Continue Reading

CMS Announces 3-State Medicare Prior Authorization Model for Repetitive Nonemergent Ambulance Transport

In light of government reports finding high utilization and potential improper Medicare payments associated with repetitive scheduled nonemergent ambulance transports, CMS will test a prior authorization model program for these services in New Jersey, Pennsylvania, and South Carolina. CMS defines repetitive ambulance service as medically necessary ambulance transportation that is furnished in 3 round trips or … Continue Reading

CMS Again Extends Moratoria on Enrollment of HHAs, Ambulance Suppliers in Designated Areas

CMS has announced that it is extending for an additional 6 months its current enrollment moratoria for new ground ambulance suppliers and home health agencies (HHAs)within designated metropolitan areas. The moratoria, which affect enrollment in Medicare, Medicaid, and the Children’s Health Insurance Program, apply to new ground ambulances in the Houston and Philadelphia metropolitan areas and … Continue Reading

CMS Call on Medicare DMEPOS, Ambulance Prior Authorization Initiatives (June 17)

CMS is hosting a Special Open Door Forum on June 17, 2014 to provide an overview regarding new Medicare prior authorization initiatives impacting durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers and ambulance suppliers. Specifically, the call will cover the Medicare Expanded Prior Authorization Demonstration for Power Mobility Devices (PMDs) Demonstration, the Hyperbaric Oxygen and … Continue Reading

CMS Releases Physician-Specific Medicare Charge/Payment Data

CMS has released its highly-anticipated data files with Medicare payment data for individual Medicare physicians and certain other Part B suppliers as part of the Obama Administration’s initiative “to make our healthcare system more transparent, affordable, and accountable.” Specifically, the “Physician and Other Supplier Public Use File” contains information on utilization, payment (allowed amount and Medicare … Continue Reading

CMS Extends and Expands Moratoria on Enrollment of Home Health Agency, Ambulance Suppliers in Designated Areas

Citing significant potential for fraud and abuse, CMS has announced that it is temporarily suspending new home health agency (HHA) and ground ambulance enrollment in Medicare, Medicaid, and the Children’s Health Insurance Program in several geographic areas, and it is extending the current enrollment moratoria for these provider types in separate areas. Specifically, effective January … Continue Reading

OIG Assesses Growth in Medicare Ambulance Transport Utilization

This post was written by Nancy Sheliga. In September 2013, the OIG issued a report on changes in the use of Medicare Part B ambulance transports from 2002 through 2011, including an analysis of the characteristics of beneficiaries, suppliers, and transports. The report found that between 2002 and 2011, the number of ambulance transports increased by … Continue Reading

CMS Sets 1% Payment Update for Medicare Ambulance Rates in 2014

The Medicare ambulance fee schedule will be increased by a 1.0% inflation adjustment for 2014, CMS announced in a recent transmittal.  This update reflects a 1.8% increase in the consumer price index for all urban consumers (CPI-U), which is partially offset by a -0.8% multi-factor productivity adjustment mandated by the ACA. The 2014 ambulance fee … Continue Reading

CMS Announces First Temporary Moratoria on HHA, Ambulance Supplier Enrollment in High-Risk Areas under ACA Authority

On July 26, 2013, CMS announced temporary moratoria on enrollment of new home health providers and ambulance suppliers under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in three parts of the country identified as “fraud hot-spots.” This is the first time the agency is exercising its authority under the Affordable Care Act (ACA) … Continue Reading

MedPAC Report to Congress on Delivery Reform

The Medicare Payment Advisory Commission (MedPAC) has released its June 2013 Report to the Congress on Medicare and the Health Care Delivery System. The report examines a number of potential ways to reform Medicare, including the following:  Redesigning the Medicare benefit. MedPAC continues to discuss the concept of competitively determined plan contributions (CPC), under which … Continue Reading

Proposed Rule Would Reward Medicare Fraud Tipsters up to $9.9 Million, Revise Medicare Provider Enrollment Regulations

This post was written by Scot T. Hasselman, Andrew C. Bernasconi, Susan A. Edwards and Debra A. McCurdy. Yesterday the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would dramatically increase the potential reward to an individual who provides a tip leading to the recovery of Medicare funds from a current … Continue Reading

MedPAC Meeting on Medicare Policy Issues (Nov. 1-2)

MedPAC is meeting on November 1 -2, 2012 to discuss a variety of Medicare policy issues, including: Medicare payment for ambulance services, reducing the hospitalization rate for Medicare beneficiaries receiving home health care, Medicare payment for outpatient therapy services, geographic adjustment of payments for the work of physicians and other health professional, the role of … Continue Reading

GAO Highlights Increasing Medicare Ambulance Provider Costs

The GAO has released a report examining Medicare payments and provider costs for ground ambulance services, along with beneficiary utilization of ambulance services. The GAO found that in 2010, costs per transport varied widely among ambulance providers in the GAO’s sample, ranging from $224 to $2,204 per transport, with a median cost of $429.  The … Continue Reading

New Law Provides Short-Term Medicare Physician Fee Schedule Fix and Extends Expiring Medicare Provisions for Two Months

On December 23, 2011, President Obama signed into law H.R. 3765, the Temporary Payroll Tax Cut Continuation Act of 2011.  Among other things, the law freezes Medicare physician fee schedule (MPFS) rates at 2011 levels through February 2012, temporarily averting a scheduled 27.4% cut under the statutory Sustainable Growth Rate (SGR) formula. The measure also extends … Continue Reading

CMS Updates End-Stage Renal Disease (ESRD) PPS for 2012

On November 10, 2011, CMS published a final rule to update Medicare ESRD PPS rates and policies for CY 2012. The rule increases ESRD payment rates by 2.1% as a result of a 3% market basket increase that is reduced by 0.9% productivity adjustment (mandated by the ACA). The rule also impacts a variety of other … Continue Reading

CMS “Provider Compliance Group Outreach Calls” to Focus on Medicare Vulnerabilities (Aug. 23-25, 2011)

CMS has announced a series of calls on specific Medicare program vulnerabilities identified in HHS Office of Inspector General (OIG) reports. The topics of the calls are as follows: August 23: Inpatient Rehabilitation Facility Documentation, Power Wheelchairs/Power Mobility; August 24: Overview of Reviews, Hospice, and Electronic Submission of Medical Documentation (esMD); August 25: Diagnostic Radiology … Continue Reading

CMS Issues Proposed CY 2012 Physician Fee Schedule Rule

July 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published its proposed update to the Medicare physician fee schedule (MPFS) for calendar year (CY) 2012. Most notably, the proposed rule calls for a negative 29.5% update for 2012 under the statutory sustainable growth rate (SGR) formula. For 2012, CMS projects a conversion factor of $23.9635, compared … Continue Reading

CMS Proposes CY 2012 Changes to End-Stage Renal Disease (ESRD) PPS

On July 8, 2011, CMS published a proposed rule that would update the ESRD PPS for CY 2012.  CMS projects that payment rates would increase by 1.8% under the proposed rule as a result of a 3% market basket increase that is reduced by 1.2% productivity adjustment (mandated by the ACA). The rule also would impact a … Continue Reading

CMS Calls: Provider Compliance Group National Outreach/OIG Reports (March 22-24)

CMS is hosting three listening sessions on provider compliance issues March 22-24, 2011, focusing on a number of OIG reports. The schedule is as follows: Tuesday, March 22 • Inappropriate Medicare Payments for Transforaminal Epidural Injections Services • Medicare Part B Services During a Non-Part A Nursing Home Stays: Mental Health • Medicare Part B services … Continue Reading

Changes in Air Ambulance Industry

The GAO recently issued a report examining changes in the air ambulance industry in the last decade and the implications of these changes on the availability of air ambulances and patient services. The GAO found that while the number of patients transported by helicopter air ambulance increased by about 35% from 1999 through 2008, the number … Continue Reading