A friend emailed recently about transport bills her hospital clients received from an ambulance service. The volume of bills seemed excessive. She questioned me about when it was appropriate to bill a hospital for ambulance transport. I answered her question, sent her some regulatory guidance, an...

As I noted in a recent post, 2018 has many numbers that effect EMS operations, documentation and billing. Today’s number is 33. EMS providers may not realize that on average, 33% of all Medicare beneficiaries are now enrolled in commercial Medicare plans (per the Kaiser Family Foundation). ...

Medicare just announced that major overpayments were received by ambulance services who render Advanced Life Support (ALS) services. CMS says that improper payments for ALS services is projected at $226 million. Released September 12, 2016, the Medicare-Fee-for-Service 2015 Improper Payments ...

Got an interesting call this week. The provider wanted to know if they could “GY” an ALS transport (which is a way to request a denial from Medicare).  In other words, they wanted to bill the patient for an ALS transport. The patient was driven by a family member to an urgent...

There’s a situation that creeped up on ambulance services and became part of everyday life before many fully realized what was happening – Medicaid transports became a larger part of your daily transport volume and consequently, a larger part of your payer mix. So, if you are doing mo...

I often get asked, “should we even bother appealing these claims denials?” The question is quickly followed by comments expressing aggravation like, “this WAS a medically necessary trip!” Or, “if we appeal, it takes AGES to get through the process.” Ambulance p...

I heard a bone chilling story recently about an ALJ hearing (Administrative Law Judge – part of the Medicare appeals process). The story came from a participant in the hearing. During the hearing, the judge was driving in his car. The cell phone in the car kept dropping the call. In a few m...

On the personal side, this story has a good ending; not-so-much on the professional side. I’m worried for EMS. There’s another hit coming your way – you’ve got both ICD-10 and new Medicare issues coming October 1st. Novitas has released their new LCD for ambulance and it&r...

There’s a big anniversary bash this week – today, July 30th, Medicare marks 50 years of coverage! President Johnson signed legislation that established Medicare for the elderly and Medicaid for low-income adults, children, pregnant women and people with disabilities. In the ambulance ...

Are you caught in the provider versus payer struggle? Benefit limitations, prior authorizations, ICD-10 and patient education are the top reimbursement struggles we see facing providers today. Here are suggestions to help. 1.       Benefit limitations, whether Me...

Medicare appeals getting denied? You’re not alone. The OIG released a report on October 3rd which reviewed the redetermination process. Ambulance services typically provide Part B services.  The OIG report reviewed redeterminations filed from 2008 through 2012. Surprise! Both the volum...

Good news for a change – HHS Secretary Kathleen Sebelius has accepted a recommendation from the National Association of Insurance Commissioners (NAIC) that cost-sharing for Medicare Advantage plans (Medicare Part C) will remain steady…..at least for the time being. Commercial Med...

  FBI Assistant Director Hosko and Attorney General Holder announced yesterday that eight cities were hit by the Medicare Fraud Strike Force this week. The net result was charges against 89 individuals for submission of $223 million in false billings. Ambulance services were included in ...