Several notable changes have been initiated under the Final 2016 Physician Fee Schedule Rule for ambulance services on November 16, 2016
Change in Bonus Payment Extensions
The Medicare ambulance fee schedule amounts for ground ambulance services, which was increased last in July 2008, has now been extended further until December 31 2017. Section 203 extends the provision increasing Ambulance Fee Schedule amounts by
- 2% for ground transports originating in urban areas
- 3% for ground transports originating in rural areas
- 22.6% for ground transports originating in an area that is within the lowest 25th percentile of all rural areas arrayed by population density, known as super-rural areas
All these three provisions will expire on December 31, 2017, unless Congress chooses to extend them beyond that date.
Change in Zip code affecting reimbursements
For ambulance fee schedule purpose, CMS brought in the ZIP code changes that went into effect on January 1, 2015. Geographic designations for approximately 95.22 percent of ZIP codes are however left unchanged
Why is this significant?
ZIP codes changes from urban to rural and rural to urban will have their impact on billing reimbursements especially for rural pickups
CMS increases the mileage rate by 50 percent for each of the first 17 miles and the rural bonus is 3%
- More ZIP codes have changed from rural to urban (1,600 or 3.73 percent) than from urban to rural (451 or 1.05 percent)
- The state of Ohio has the most ZIP codes that changed from urban to rural with a total of 54, or 3.63 percent of all ZIP codes in the state.
- The state of West Virginia has the most ZIP codes that changed from rural to urban (149 or 15.92 percent of all ZIP codes in the state).
And for air ambulance services
Where the point of pick-up is in a rural area, the total payment (base rate and mileage rate) is increased by 50 percent.So, if a point of pickup (POP) ZIP code changed from rural to urban, an ambulance service receives less Medicare reimbursement (and vice-versa if a POP ZIP code changed from urban to rural).
Changes in Ambulance staffing regulations
All ambulance transports must be staffed by at least two people who must meet the requirements of applicable state and local laws where the services are being furnished, and the current Medicare requirements.
For Basic Life Support (BLS) vehicles, at least one of the staff members must be certified at a minimum as an emergency medical technician-basic (EMT-Basic).
Revision of the definition of BLS: Basic life support (BLS) means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffed by an individual who is qualified in accordance with State and local laws as an emergency medical technician-basic (EMT-Basic). These laws may vary from State to State. For example, only in some States is an EMT-Basic permitted to operate limited equipment on board the vehicle, assist more qualified personnel in performing assessments and interventions, and establish a peripheral intravenous (IV) line. This has now been deleted as CMS states that may not accurately reflect the status of the relevant state laws over time
Note: The reduction for non-emergency BLS transports to and from dialysis treatment facilities that became effective on October 1, 2013 is not reflected in the Ambulance Fee Schedule Public Use File. The 10% reduction is taken at the time of claim payment.