Thursday, December 9, 2010

Congress Passes Medicare Ambulance Relief Extensions/Announcement of the 2011 AIF

Ambulance Relief Extended for One More Year!

We have learned that Congress, today (Thursday, December 9th), passed what's being referred to as the "physician fix extension." This extension, meant to cover shortfalls in Medicare payments to doctors that were anticipated in the New Year, also included another one-year extension of Medicare ambulance relief. This relief includes the 2% Urban, 3% Rural and 22.6% Super Rural bonus payments that have been in place for the last few years.

The Senate reached its agreement late last night and the House passed the measure earlier today.

Funding for Retroactive Relief Processing is Included...

Also, as part of this measure, $200 million has been allocated to pay Medicare Administrative Contractors (MAC's) to assist in the costs to reprocess retroactive relief for the first six months of 2010. This will mean that we should finally soon see retroactive payments for claims submitted prior to July 6th when Congress voted to extend the Medicare relief that expired on December 31, 2009 without immediate extension. Although under direction from Congress to pay in July, the Center for Medicare and Medicaid Services (CMS) and the associated MAC's (with exception of Trailblazer Health Enterprises for our Virginia clients) have yet to issue this retroactive relief payment due to the claimed heavy cost to properly issue those payments. This funding allowance should now clear any logjam for CMS to force the MAC's to issue retroactive relief as soon as possible.

Ambulance Inflation Factor (AIF) Announced...

As part of yesterday's CMS Ambulance Open Door Forum, the 2011 AIF was announced.

In calendar year 2011, the AIF will be a negative one-tenth of one percent (-0.1%). This will most likely mean a slightly negative adjustment to the Medicare Ambulance Fee Schedule. Actual approval rates will not be published until later this month due to expected adjustments in the regional Gross Practice Cost Indices (GPCI's), which are part of the health care cost computations for all medical disciplines.

You'll recall our earlier e-mail and Blog posting describing how the AIF calculation is determined, using the new Multi-Factor Productivity (MFP) adjustment as part of the equation. The industry is seeing a negative adjustment for the first time since the inception of the Medicare Ambulance Fee Schedule, with the addition of the MFP into the calculations.

Bullet dodged...

Thanks to quick action by Congress over the past two days, a potentially larger loss of Medicare reimbursements was offset by the decision to extend the bonus relief payments. Had a negative AIF combined with the loss of the bonus relief dollars, the impact to EMS, nationwide, would have been fairly significant. As it is, we never like hearing about losses in reimbursement dollars, but all things considered the results could have been much more painful.

We welcome your comments on this or any other Ambulance Billing Bl0g topic.
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