On June 19th in Philadelphia, there were 913 EMS responses.

NINE HUNDRED AND THIRTEEN!!

In one day.

Not every response will result in transport. For many responses, the ambulance is cancelled. But for other responses, EMS dispatched expensive resources (trained personnel and fully equipped ambulances). The crew arrived. They assessed the patient. Occasionally, the issue is low acuity and the crew handles the patient and moves on. There is no transport. There was response, some treatment, but no transport.

Our healthcare partners – hospitals, home health agencies, hospice services and visiting nurses – have learned that there is more we can do for to support their work. EMS follows up on discharged patients which curtails readmissions. Paramedics can fill the gap until the visiting nurse begins service, or, assist after-hours for home health and hospice services.

In the meantime, there is a virtual s**tstorm of audit activity raining down on the ambulance industry. Emergency services were targeted for overbilling ALS-1 emergencies to the tune of $226 million. Next there are the “TPE” (Targeted Provider Education) audits going on nationwide. Finally, the OIG announced last week that Medicare “improperly paid providers for nonemergency ambulance transports to destinations not covered by Medicare.” According to the OIG’s findings, there is $8.7 million in overpayments that they recommend be recovered. The government believes the industry has some issues.

 Then there is the arrival of Lyft and Uber in the medical transport business. These ride-sharing companies have targeted the transport of patients to routine appointments.

 

 How does this all tie together? Clearly, the ambulance industry – both emergency and non-emergency – is in a period of transition. We have learned much about how we can serve patients and communities. We are evolving. Transport is not always the best approach. Yet response is one of the things the industry does best. Thus, community paramedicine grows. CP is an appropriate response for much of the change faced by this industry.

 

 BUT, providers need payment for these essential (and economical) services. Patients, communities and healthcare providers all benefit from the CP approach. It is also a good allocation of our industry’s well-trained human resources as well as a good application of our capital resources.

 

 Many states are forward-thinking about CP. Pennsylvania made recent strides. Georgia implemented Medicaid reimbursement for treatment without transport. Minnesota established themselves as one of the first states to embrace and reimburse these services. Then there was the surprise that came when Anthem Blue Cross decided to pay. Progress!

 

 We need to continue to “bang the drum” to payers and legislators about our evolution and the importance of CP services. Try billing commercial insurers using the A0998 code (they may not always pay, but it’s worth a shot). Remember, Medicare does not cover A0998, treatment without transport, but commercial insurers may reimburse. Look to contracting with hospitals and other healthcare partners as well as insurers.

 

 Evolution and change is not always easy. However, the ambulance industry has never steered clear of a challenge. The changes on our horizon show the promise of better patient response, better working relationships with healthcare partners and better use of our valuable human and capital resources.

 

 I’m excited for what comes next!

 

 About the author:  Maggie Adams is the president of EMS Financial Services, with 25 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. “Like” EMS Financial on Facebook, follow us on LinkedIn or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com