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Resuscitating the Ambulance Fee Schedule

If your patient was the Medicare Ambulance Fee Schedule, you’d be preparing to start CPR. The accuracy of Medicare reimbursements is going downhill, payment methodologies aren’t keeping up with industry trends and the value Medicare places on the care we provide is pathetic. Congress just brought us an AED and a drug box, and it’s time to get to work.

In February, Congress passed legislation that contained an unprecedented opportunity for the EMS world. The Bipartisan Budget Act of 2018 (P.L. 115-123) directs the Centers for Medicare and Medicaid Services (CMS) to develop a data-collection system to gather information on the costs of providing EMS care to Medicare patients. While the details of the system have yet to be decided, P.L. 115-123 gives CMS a framework to use. Congress directed CMS to develop a surveying tool to gather information on the costs, revenue and utilization rates of EMS departments.

The legislation doesn’t require all EMS agencies to report. Instead, CMS is directed to develop a random survey methodology that will be a representative sample of EMS agencies. Agencies selected will need to complete the surveys or face a 10% reduction in payments. The legislation allows an agency to seek an exemption if they believe participating will be a hardship. Additionally, P.L. 115-123 requires CMS to work with the EMS industry in developing these cost reports and processes.

This presents an important opportunity for fire and EMS agencies to prove how poorly and inaccurately CMS reimburses for prehospital care. CMS will start its surveys in 2019, and it’s imperative that fire and EMS agencies rise to this challenge.

Huge numbers of patients, such as fall victims, asthmatics, diabetics and seizure patients, are often treated on scene without Medicare reimbursement for their care. Countless others are provided costly medications for which Medicare doesn’t pay. CMS’ newly authorized cost reporting will let fire departments prove the monetary value of the services they provide.

The data generated by CMS’ cost-reporting system will be crucial in revising the Medicare Ambulance Fee Schedule. This data could open the door to long-sought reimbursements for practices such as treat-and-release and transportation to alternative destinations of care.

The IAFC will develop resources to assist fire departments selected for participation and will work with CMS to ensure cost reporting is as simple and minimally burdensome as possible. However, the desired outcome of making CMS reimbursement match fire-department costs for patient care can only be achieved if the fire and emergency service seizes this opportunity and aggressively participates. If you operate a transport service, regardless of whether it is BLS or ALS, make sure your financial information is in good order and you have a strong grasp of your revenue, expenses and EMS utilization rates.

CMS will be required to submit reports to Congress on their findings and on the accuracy of the Ambulance Fee Schedule. While their first report isn’t due until March 2023, these next few years will be crucial for ensuring the right data is collected. This data will determine whether we can actually make the Ambulance Fee Schedule provide the support America’s fire and emergency service needs.

The Medicare Ambulance Fee Schedule has been in critical condition for quite some time, but we have finally been handed the right tools to fix it. There’s a long haul ahead for this patient; are you willing to help resuscitate and stabilize this vital member of our community?


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