Novitas, the Medicare Administrative Contractor (“MAC”) for Jurisdiction 12 (covering Pennsylvania, Maryland, New Jersey, Delaware and Washington DC), released a new “Local Coverage Determination” (“LCD”). This “LCD” went into effect on April 12, 2012.

The Centers for Medicare and Medicaid Services (CMS) has issued a much anticipated Proposed Rule outlining how ambulance services should report and return overpayments under the new 60-day overpayment reporting requirement contained in the Affordable Care Act (otherwise known as the “Healthcare Reform Bill”).

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Starting January 1, 2012, Medicare contractors will have to accept and process claims for services such as wheelchair van transports, treatment without transport, and other ambulance services that are not covered by Medicare. Please note that this does not require Medicare to pay for these non-covered services, it merely requires that they process claims with non-covered service codes to facilitate coordination of benefits or payments by secondary insurers. Ambulance providers will have to submit these claims with a "GY" modifier to tell their contractor to deny them.

On May 31, 2011, the Department of Health and Human Services (HHS) issued an important Proposed Rule regarding the electronic health information that ambulance services create and maintain. If implemented as proposed, this Rule would overhaul the way the ambulance industry tracks and reports uses and disclosures of their patients’ protected health information (PHI).

The Office of the Inspector General just issued a key Advisory Opinion about offering discounted rates to skilled nursing facilities (SNFs). As many providers struggle to gain an edge in a competitive market, Advisory Opinion 10-26 reminds the ambulance industry that discounted rates could violate the Federal anti-kickback statute (AKS), even when those rates are tied things like state Medicaid rates.