On October 31 and November 1, the U.S. Advisory Committee on Ground Ambulance and Patient Billing considered recommendations to clarify billing for ambulance services and improve the disclosure of charges and fees for ground ambulance services. The advisory committee was created as part of the No Surprises Act (P.L. 116-260). Deputy Chief Pete Lawrence of the Oceanside (CA) Fire Department served on the committee as an expert in fire-based EMS.
During the meetings, the advisory committee voted to adopt the following recommendations:
- Ambulance services, not just transport, should be considered an “essential health benefit."
- Non-transport services also should be covered by all insurers.
- Rates will be set in the following order: by states; local governments (including cities, counties, and districts) through negotiations with insurers; and finally federal legislation as a percentage of Medicare as a backstop if none of the other rates are present. The rates must include reimbursement for items not covered by Medicare, such as assessment and treatment on scene. The committee recommended that local rates should be established in a public setting (e.g., council/board meeting) and data on the charges (not the costs) must be provided to the states to include in a database of established rates.
- Payment by the insurer should be direct to the EMS provider. The insurer must pay or deny a claim within 30 days. This recommendation would eliminate the issue in states without direct payment rules where the patient receives the insurance payment and then must remit full payment to the EMS provider.
- The committee recommended minimum data elements for a claim to prevent delays in insurance companies’ decisions on ambulance payment. The minimum data elements are essentially what is provided now for Medicare claims and is readily available information based on patient care record information.
- The committee also recommended boilerplate language that would be included on the ground ambulance bills to the patient so that the patients are aware of their responsibility in paying the bill.
- For common patients, the committee recommended that hospitals and other health care facilities must share patient demographic and insurance information with ambulance entities upon request.
- The committee also recommended that cost sharing be set at the lesser of 10% or $100 by the patient to protect patients from higher percentages in future insurance plans.
- A request to Congress will also be made to form a standing committee of stakeholders to discuss the addition of Community Paramedicine and ALS First Response to the list of covered EMS programs, as well as discuss the need to determine how to incorporate the increasing cost of medications, supplies and equipment into reimbursement mechanisms.
The advisory committee will draft a report about its recommendations. The final report is expected to be submitted to the Secretaries of Labor, Health and Human Services, and Treasury, and Congress late in the first quarter of next year.