Friday, June 2, 2017

Why is S. 967 So Important to the Ambulance Industry? Part IV

S.967- Part IV

Today we land Part IV of our blog posts dedicated to helping us all understand the importance of Senate Bill 967 entitled the “Medicare Ambulance Access, Fraud Prevention and Reform Act of 2017.”

Why is S. 967 So Important to the Ambulance Industry? Part IV
In that opening post, we explained that the bill addresses four areas to benefit EMS in America.
  • Reform to the Medicare ambulance fee schedule
  • Prior Authorization for ambulance transports of ESRD beneficiaries
  • Requiring providers of services and ambulance service providers to submit cost data and other information with respect to ambulance services
  • Treatment of ambulance service providers

In Week One we focused on how the bill proposes to permanently incorporate the add-on bonus payments to the Medicare ambulance fee schedule. Week Two’s discussion centered on the proposal to add a Prior Authorization process for pre-approval of all ambulance transports provided to ESRD beneficiaries to and from dialysis treatments.

Last week, we focused on the “bitter pill” in this proposed legislation, as we explained our view of the provision that will request that we all submit costs data and information about our day-to-day operations.

Now, to bring this all to a landing; we’ll take a look at the move from being an ambulance supplier to a provider of service

Historically…

Since Medicare began paying for ambulance transports, the Feds have considered us a supplier of services.

CMS defines a supplier as…
“A company, person, or agency that’s been certified by Medicare to give you a medical item or service except when you’re an inpatient in a hospital or skilled nursing facility.” (Medicare.gov Glossary of Terms)
In contrast, a Medicare provider is defined as…
“A health care provider (like a home health agency, hospital, nursing home or dialysis facility) that’s been approved by Medicare.”

What’s the difference?

The real difference that makes this provision so important is that the federal Medicare program has a very different view of suppliers versus providers aside from the bland definitions.

A provider is one who cares for patients by providing treatment to patients.

Suppliers are those who furnish goods and services used in patient care and treatment.
  
By moving us from a furnisher of goods and services to the realm of someone or, in the case of an ambulance service, to a group a people who provide treatment; it opens the door for EMS to be paid by Medicare (and then hopefully by extension to other payers- Medicaid, commercial insurers, etc.) for providing treatment possibly without providing transportation.

The End Goal

The end goal of all of this is to open the door for all of us to be reimbursed in ways that we have not heretofore been considered for reimbursement.

Can this provision open the door for reimbursement for Mobile Integrated Health Care (MIHC/Community Paramedicine) covering wellness checks and services such as preventative care in the field? Will we now see reimbursement begin to flow when we treat a diabetic patient and the patient chooses to not be transported? Will we finally be recognized for the individual services we provide and ultimately shed the title “ambulance driver” from patients’ vocabularies?

Don’t miss the significance of this change. It’s huge!

Imagine removing the stress from what we do as we wrestle with protocols that sometimes encourage us to not transport versus receiving reimbursement to pay for our services if we do transport, as is the current case.

Savings

Of course, Congress and the bureaucracy that supports Medicare also recognizes that, as many experts have demonstrated, such a move may just save the Medicare system precious dollars. Potentially, the move will have an effect on fraud and abuse where unscrupulous ambulance suppliers nudge their staff toward transporting to help pay the bills even when the scenario may not warrant transportation.

Potentially, we can treat a patient and feel more comfortable about advising against transport and still get paid for the treatment we have provided minus an actual transport.

Plus, by being eligible to be reimbursed for treatments in the field the system will support follow-up with chronically ill patients to lessen their need for emergency services thus relieving a growing burden on emergency services through preventative measures- taking the strain and the cost off, not only pre-hospital providers, but also stressed emergency departments.

The potential

S.967 has the potential to change our EMS world in the United States.

Now you know what it is, so it’s time to get out there and lobby our Federal lawmakers to pass this measure. You have a voice…time to make yourself known!

The Ambulance Billing Services blog is brought to you as a service by Enhanced Management Services, Inc. Enhanced Management Services, Inc. is a full-service, all-EMS third-party billing contractor with Fire/EMS clients located across the United States. For more information about how Enhanced can benefit your EMS agency, please visit our website at www.enhancedms.com and click on the “Get Started” button on any landing page.

Post a Comment