Permanent Medicare Ambulance Relief Bills
A bill recently introduced in the Senate would provide a permanent 6 percent Medicare increase for ambulance transports originating in urban or rural areas and permanently extend the bonus base payment of 22.6 percent for ambulance transports originating in super rural areas. Click here to read more. The relief from the Medicare Ambulance Access Preservation Act (MAAPA) would be in place of any temporary Medicare ambulance relief beyond 2010 and not in addition to it. The AAA will continue to pursue efforts for the extension of the temporary Medicare ambulance relief provisions as well as advocate for passage of MAAPA as the permanent solution to below-cost Medicare ambulance reimbursement.

MAAPA was introduced in the Senate by Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Jeff Sessions (R-AL) and in the House by Congressmen Richard Neal (D-MA) and Fred Upton (R-MI).  The AAA was successful in efforts to extend the temporary 2 percent urban, 3 percent rural and super rural bonus increases until the end of 2010
 
The Signature Crackdown

It’s time to brush up on your penmanship. CMS is cracking down on illegible signatures from physicians and crew members at the bottom of patient ambulance forms. The bottom line: if they can’t read it, they’re not accepting it.  If there’s no signature, it will be turned down as well. Stamped signatures will not be accepted. Electronic signatures are acceptable but it must be through a method that permits verification. In addition, patient care reports should be signed by the crew members who provided the service.

 
Red Flag Rules Delayed Again
Enforcement of the Red Flag Rules on Identity Theft has been delayed until Dec. 31, 2010. The Red Flag Rules require creditors, including ambulance services, to develop and implement a written Identity Theft Prevention Program to prevent, detect or diminish identity theft relating to new and existing accounts. Click here to read more. The written program must include reasonable procedures to combat identity theft through a series of discerning Red Flags. These are defined as a pattern, practice or specific activity that indicates the possible existence of identity theft.  Each program must be formally approved by the EMS/ambulance service’s board of directors or an appropriate committee of the board. An appointed board member or members must commit to overseeing the development, implementation and administration of the program. This must also include staff training to effectively implement the program and a designee to oversee the provider arrangement. We recommend the PWW Red Flag Rules Survival Kit to help ambulance services effectively deal with the new rules. If you are an EMS Billing Services client you can receive a discounted price.   


New Ambulance Tax Laws Being Considered
Automobile insurance companies are fighting a provision that would require automobile insurance to cover the costs of emergency services that come to the scene of an accident. Currently, eight states have a ban on the response fees provision. In addition, a growing number of states are trying to enact a direct pay process so that accident response fees are charged directly to the patient or person involved in the accident. Click here to read more. Up to 26 states have enacted or are trying to enact this legislation. Organized opposition to the legislation states that this a form of double taxation since public tax dollars already pay for first-responders in many large cities.

Health insurance companies also oppose this legislation in favor of allowing ambulance service charges to be a part of insurance coverage. Health insurance companies use direct pay coverage to get ambulance services to sign up for discounted rate contracts.


CMS Reverses Stance on Ambulance Coverage
CMS recently rescinded its position to allow states to exclude coverage of non-emergency transportation services from Medicaid services as of July 1,2010. Now all state Medicaid plans must cover transportation services plans. Click here to read more. Essentially this means that every state Medicaid plan (standard Medicaid plans, benchmark plans, and benchmark equivalent plans) must cover both emergency and non-emergency transportation services.  The Final Rule also goes a step further in providing that even if the Medicaid plan does not expressly include a transportation benefit, the state is still obligated to provide it.

Healthcare Reform Brings Changes to Ambulance Services
The new healthcare reform is expected to have a significant impact on ambulance services. One of the biggest changes is an extension of the 2 percent urban, 3 percent rural and super rural bonuses for ground ambulance service providers through the end of 2010 and retroactive to Jan. 1, 2010.The Centers for Medicare and Medicaid Services (CMS) is expected to provide guidance on how the retroactive bonuses will take effect shortly after the bill is signed. In addition, there are many other important provisions in the bills that could have an effect on reimbursement rates, as well as operational and compliance costs for ambulance services. These include eliminating insurance company practices of lifetime caps, dropping policies for pre-existing conditions, expanding Medicaid eligibility, and requiring 32 million uninsured Americans to obtain health insurance. This could mean that more ambulance patients will be insured and fewer accounts will fall into the "self pay" or "uncollectible" categories. Ambulance providers that purchase health insurance for their employees may also be eligible for a small employer tax credit. Check for new updates in our next newsletter or on our website under the news section at www.emsbillingservices.com.

Ambulance Suppliers Prepare for 5010
Have you begun preparing for the changes that will take effect with the implementation of 5010, also known as HIPAA2? Medicare contractors are expected to begin testing with submitters as early as January 2011. EMS squads must begin using the 5010 formats by January 2012. As the supplier, it is your responsibility to talk to your vendor and/or clearinghouse about their plans for implementing 5010.

The 5010 version includes changing over to an electronic format and requiring information like the point of pick-up (2310E) and point of drop-Off (2310F) locations (suppliers previously reported pick up in 2310D facility loop); required diagnosis codes; changes to the Ambulance Certification record (CR1) and Condition Codes (CRC). Your billing systems will need to be able to capture the appropriate information and report it on an electronic claim.

Hospice Change Reduces Denials
Denials for hospice patient transports should be reduced with a change made to the Centers for Medicare and Medicaid Services (CMS) benefits. The change involves patients who are transported on the same day that the patient signs up for hospice benefits. Transmittal 121 in the CMS Benefit Policy Manual, 100-02, Chapter 9, section 40.1.9, directs its contractors to pay ambulance transports of hospice patients, which occur on the effective date of the hospice election as an ambulance benefit and not the hospice benefit. This means that when a patient is being discharged from a hospital and transported to a location where they will sign the form electing hospice benefits, the claim for the ambulance transport will be paid by the carrier/intermediary /Medicare Administrative Contractor and not denied as the responsibility of the hospice.

The claim will now be based on the date the patient elected hospice benefits plus one day. For these transports, continue to use the "GW" modifier. The transport will not be tied to the patient's terminal illness for which he or she is receiving hospice benefits. This is effective for dates of service on or after July 6, 2010.

Permanent Medicare Ambulance Relief Bills Progress
A more permanent Medicare ambulance relief bill is picking up support in the House and Senate. The Medicare Ambulance Access Preservation Act (MAAPA) would provide a permanent 6 percent Medicare increase for transports originating in an urban or rural area and permanently extend the bonus base payment of 22.6 percent for transports originating in super rural areas. MAAPA was introduced in the Senate by Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Jeff Sessions (R-AL) and in the House by Congressmen Richard Neal (D-MA) and Fred Upton (R-MI).

Do You Need A Business Associate Agreement?
Are you protecting the confidentiality of your patients? If your EMS unit works with city personnel to process your patient records, it is your responsibility to ensure that any patient information that passes through the hands of city personnel remains confidential and will not be released to the public in compliance with HIPAA laws.To protect the welfare of your rescue department, you should consider establishing a business associate agreement with the city that spells out the responsibility of city personnel in dealing with protected health information (PHI). We recommend that you seek legal council to ensure there is a sufficient process in place.

HHS Employs Tougher Standards for Improper Medicare Payment Rates
Improper payments will receive greater scrutiny in 2010. As part of the Obama Administration’s goal of reducing waste, fraud and abuse in Medicare, the Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) significantly revised and improved its calculations of Medicare fee-for-service (FFS) error rates in 2009. These improvements will provide CMS with more complete information about errors so that the agency can better target improper payments. CMS is taking further steps to ensure:

• Providers are submitting all required clinical and medical documents to support a claim.
• Providers’ signatures on medical documents are legible.
• A provider’s claims history can no longer be used to fill in missing treatment documentation.
• A requirement that medical information from a health care provider be included to support durable medical equipment claims, in addition to the records from suppliers.

Improper payment rates in Medicaid include those payments that may have been paid incorrectly and, as in Medicare, do not necessarily reflect fraud. The vast majority of Medicaid errors are due to inadequate documentation. This includes providers either not submitting information to support their FFS or managed care claims or not submitting additional data when requested. Other errors are due to services provided under Medicaid to beneficiaries who were not eligible for Medicaid coverage or for the services received.

CMS established the Comprehensive Error Rate Testing (CERT) program to calculate a national paid claims error rate for all of the Medicare Fee-For-Service program. The CERT program calculates the error rates for all Medicare Administrative Contractors (MACs) and, until the transition to MACs is completed, the CERT program will also report on carriers, and Fiscal Intermediaries (FIs).

0% Inflation Factor Means No Payment Increases
Payment for services will not be increased this year. The Social Security Act provides the basis for updating payment limits for ambulance services. The Social Security Act provides for an update in payments for 2010 that is equal to the percentage increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year. The resulting percentage is referred to as the AIF. Since the CPI-U for 2010 is a negative number (-1.4%), and the Act specifically provides for a percentage increase in the AIF only, the resulting AIF for CY 2010 will be held at zero percent. The history of the AIF for the last several years includes: 2003: 1.1, 2004: 2.1, 2005: 3.3, 2006: 2.5, 2007: 4.3, 2008: 2.7, 2009: 5.

From the American Ambulance Association
Medicare Ambulance Relief included in Health Reform Proposal
In June, a health care reform proposal was passed that includes Medicare ambulance relief in the form of a two-year extension of the 2 percent urban and 3 percent rural increases from the Medicare Improvements for Patients and Providers Act enacted last year. As a result, the current increases would expire on Jan. 1, 2012 instead of Jan. 1, 2010. Click here to read more.

Proposed Medicare Ambulance Access Preservation Act Ups Mileage Rates
The Medicare Ambulance Access Preservation Act (MAAPA) was introduced in the United States Senate by Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Jeff Sessions (R-AL) and in the U.S. House of Representatives by Congressmen Richard Neal (D-MA) and Fred Upton (R-MI). The legislation would implement, starting Jan. 1, 2010, a permanent 6 percent increase to base and mileage rates under the Medicare ambulance fee schedule and permanently extend the bonus base payment of 22.6 percent for transports originating in super rural areas. The increases are supported by the findings of the May 2007 report by the Government Accountability Office on the costs of providing ambulance services. These permanent increases would offset reductions in payments from the loss of the current temporary Medicare ambulance relief provisions which all expire at the end of this year. Click here to read more.

Health and Human Services Intensifies HIPPA Enforcement
 Just when you thought you understood all there was to know about the Health Insurance Portability and Accountability Act (HIPAA), now there’s more. A recent ruling made by the U.S. Dept. of Health and Human Services (HHS) has strengthened penalties for violations of HIPAA, providing a maximum penalty of $1.5 million for all violations of an identical provision. The ruling incorporates revisions made by the Health Information Technology for Economic and Clinical Health Act (HITECH). Before its enactment, the HHS could not impose a penalty of more than $100 for each violation or $25,000 for all identical violations of the same provision. A covered entity could also bar the imposition of a civil money penalty by demonstrating ignorance of being in violation of HIPAA rules. The HITECH Act enhances the civil money penalty policy by establishing four tiered ranges of minimum penalty amounts with a maximum penalty of $1.5 million for all violations of an identical provision. In addition, a covered entity is no longer exempt from the imposition of a civil money penalty for an unknown violation unless it corrects the violation within 30 days of discovery. The four tiers of penalties are:
Tier 1:  If the covered entity did not know it was in violation of HIPAA, the fine for violation is a minimum $100 for each violation up to $25,000, and a ceiling of $50,000 per violation.
Tier 2: If the violation was due to reasonable cause, but not willful neglect, the penalty is a minimum of $1,000 per violation up to $100,000 within a calendar year, with a maximum of  $50,000 per violation.
Tier 3: If the violation was due to willful neglect, but was corrected, the penalty is at least $10,000 per violation up to $250,000 for identical violations, and a maximum of $50,000 per violation.
Tier 4:  For violations due to willful neglect that a covered entity did not correct, the fine is a minimum of $50,000 for each violation, not to exceed $1.5 million for the calendar year.

Your Legible Signature May Impact Reimbursement
 Your John Hancock is undergoing more scrutiny than ever. The CERT (Contractor Error Rate Testing) Review Contractor (CRC) has announced that it may assess penalties when medical record documentation does not include a legible signature. To avoid penalties, WPS Medicare advises providers to make certain their signature is legible and to include a signature sample when responding to CERT Documentation Contractor (CDC) request for medical records.

Recovery Audit Contractors to Identify Improper Medicare Payments
Recovery Audit Contractors (RACs) have been appointed by Congress to identify improper Medicare payments. The auditing companies will send you a request letter asking for patient care reports to review the documentation. If you should receive a RAC letter requesting medical records, please send the letter immediately to EMS Billing Services. These requests must be answered within 45 days or you will be asked to send the Medicare payment back. All EMS Billing Services account managers have received RAC training by HealthData Insights in Lincoln, Neb. Auditors in your state include: Nebraska, Iowa, Kansas, Missouri and Wyoming: HealthDataInsights Inc.; and Louisiana, New Mexico and Colorado: Connolly Consulting Associates Inc.

Iowa Providers Subject to Audits
Beginning in November of 2009, audits will be performed on providers enrolled in the Iowa Medicaid Program. The audits will be conducted by Health Integrity, the Centers for Medicare and Medicaid Services’ (CMS) Medicaid Integrity Contractor (MIC) according to Generally Accepted Government Auditing Standards. If selected for an audit, providers will be expected to submit records in a timely manner as required in 1AC441-79.3 Maintenance of Records by Providers and 79.4 Reviews and Audits.