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Ambulance Fee Schedule Summary

From Miranda Franco of Holland & Knight dated December 10, 2013:

Please note extenders (such as ambulance add-on payments) are not included in this draft. We are hearing that Senate Finance will bring up extenders during their mark-up on Thursday. It is unclear what Ways and Means will do.



There is a chance extenders will be included in a short term SGR path with the unemployment insurance extension and any other end of the year wrap up items.  Additionally, the Medicare Physician Fee Schedule final rule was released on November 27. Below is a summary of the ambulance fee schedule section.

Ambulance Fee Schedule

·         A 3 percent payment increase for covered ground ambulance transports that originate in a rural area or in a rural census tract of a metropolitan statistical area (through December 31, 2013).

·          A 2 percent payment increase for covered ground ambulance transports that do not originate in previously mentioned rural areas or census tracts (through December 31, 2013).

·          A 22.6 percent rural bonus for ground ambulance services where transportation originates in a qualified rural area (through December 31, 2013).

·          A 10 percent reduction in payment for ambulance services furnished on or after October 1, 2013, consisting of non-emergency basic life support services involving transport of an individual with end-stage renal disease for renal dialysis services furnished other than on an emergency basis by a provider of services or a renal dialysis facility.

In the proposed rule, CMS also noted that section of the American Taxpayer Relief Act (ATRA) that requires the Secretary to conduct the following studies:

(A) A study that analyzes data on existing cost reports for ambulance services furnished by hospitals and critical access hospitals, including variation by characteristics of such providers of services, with a report to Congress on such study due no later than October 1, 2013; and

(B) A study of the feasibility of obtaining cost data on a periodic basis from all ambulance providers of services and suppliers for potential use in examining the appropriateness of the Medicare add-on payments for ground ambulance services under the fee schedule under section 1834(l) of the Act and in preparing for future reform of such payment system, with a report to Congress due on such study no later than July 1, 2014.

ATRA required the Secretary to consult with industry on the design of the cost collection efforts described for the second study, and CMS said it was using the proposed rule to collect information, comments, and ideas from the industry on these matters. In the final rule, CMS acknowledges that several organizations provided detailed comments on the issues (but does not summarize these comments) and says it will consider them as it performs the study.

Miranda Franco | Holland & Knight

Sr Public Affairs Advisor