Two big changes are coming for employers, and they both go into effect on April 30, 2012.

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).

CMS Announces Plan for Retroactive Bonus Payments

Ambulance services should soon begin to receive the long awaited retroactive “bonus” payments that were implemented by the Affordable Care Act (ACA) last March. The Centers for Medicare and Medicaid Services (CMS) just announced that it will begin to reprocess affected claims from the first half of 2010 over the next several weeks.

On February 2, 2011 the Centers for Medicare and Medicaid Services (CMS) published a Final Rule that drastically enhances the government’s ability to crack down on fraud and abuse in federal healthcare programs. For the ambulance industry, this means increased compliance obligations and more scrutiny from federal and state investigators.