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Patching Patients and Ambulance Payments

Just as fire departments are trying to beat the clock when treating patients, Congress is trying to beat the clock on reauthorizing important Medicare payments for EMS services.

The current Medicare Ambulance Fee Schedule draws ire across the United States for its chronic under-reimbursement of fire departments for the care they provide to Medicare beneficiaries. Medicare's additional payment for transporting Medicare beneficiaries will expire on April 1 unless Congress acts to extend the authorization.

The Medicare Ambulance Add-On Payment was initially created to incentivize ambulance services in underserved areas; it provides the following additional payments for transports originating in predetermined zip codes:

  • Urban: +2%
  • Rural: +3%
  • Super-rural: +22.6%

One of the biggest issues with the current Medicare Ambulance Fee Schedule is the failure of the Centers for Medicaid and Medicare Services (CMS) to reimburse fire departments for the costs of administering medications and performing procedures such as intubation.

While the Medicare Ambulance Add-On Payments fail to fully bridge the gap between costs and reimbursements, these add-on payments are helpful in minimizing the uncovered portion of a patient's bill that a fire department must pay using their EMS budget.

Legislation Introduced

Budgeting for EMS revenue recovery in fire departments has become especially difficult because Congress has generally reauthorized these add-on payments on an annual basis. Recently, Congress even reauthorized these payments in just six-month increments.

Representative Greg Walden (R-Ore.) and Senator Charles Schumer (D-N.Y.) have sought to stabilize the authorization for the add-on payments by introducing the Medicare Ambulance Access, Fraud Prevention and Reform Act of 2015 (H.R. 745/S. 377).

This legislation would permanently reauthorize the Medicare Ambulance Add-On Payments and pay for this policy change by requiring preauthorization of nonemergent transportations of patients with end-stage renal disease (ESRD). The creation of this requirement for preauthorization of ESRD transports would also help shore up a hole in Medicare ambulance payments since the non-emergent ESRD transportation category is where CMS most frequently finds fraudulent billing.

H.R. 745/ S. 377 would also require the Department of Health and Human Services to collect a variety of data points, including cost reports from ambulance-service providers receiving CMS payments.

Does Congress Have A Vehicle?

The IAFC is strongly encouraging Congress to include H.R. 745/S. 377 when they consider other proposals related to the doc fix legislation, which is Congress' annual patch to prevent Medicare rate cuts for physicians. Congress generally includes a short-term reauthorization of the ambulance add-on payments to the doc fix, so it's possible that Congress could include H.R. 745/S. 377.

The IAFC firmly believes that Congress should include H.R. 745 and S. 377 in order to finally bring predictability to these payments and the budgeting process for fire chiefs across the United States.

If your fire department is seeing a mismatch between costs and Medicare reimbursement levels, contact your members of Congress and explain the importance of the add-on payments in providing some assistance in recovering costs.

The IAFC will continue advocating for Congress to pass H.R. 745/S. 377; however, we need you to explain the importance of these payments to your department and to ask your members of Congress to cosponsor the Medicare Ambulance Access Preservation, Fraud Prevention and Reform Act of 2015.

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