Under Proposed ACA Regulations Volunteers Could be “Employees”
DEC 13 2013
The Affordable Care Act (ACA) is aimed at getting tens of millions of uninsured Americans into the health insurance marketplace, and there are a number of ways the law goes about doing that. One major initiative, the “employer mandate,” requires employers with at least 50 full-time employees (including full-time equivalent employees) to offer health insurance to all employees that work at least 30 hours per week and their dependents. Employees that work at least 30 hours per week are considered to be full-time employees under the ACA. When the ACA was signed into law back in 2010, many assumed that an “employee” was someone who was being paid for work, not a volunteer.
New OIG Advisory Opinion Allows No Bills for Municipal Residents, But Bills for Non-Residents
JUL 09 2013
On July 9, the OIG posted Advisory Opinion 13-08, concerning a Fire Protection District ("District") policy of only billing individuals that reside outside the fire protection district for emergency medical services. Here, the District does not bill any residents or their insurers (including federal health care programs) for emergency medical services. But it does bill all non-residents (including federal health care programs) for emergency medical service under a fee schedule established by referendum.
Proposed Rule to Eliminate Ambulance Backbilling and Enhance Fraud Prevention
MAY 13 2013
CMS issued a Proposed Rule that would limit ambulance providers' ability to "backbill" Medicare for certain services and enhance some the other "fraud-fighting" Medicare regulations. It's not too late to register for an abc3 conference this spring, where we'll tackle the proposed changes and discuss how CMS is taking a cue from the IRS by increasing fraud reporting incentives.
CMS Issues Proposed Rule Affecting Scheduled, Repetitive PCS Forms
MAY 13 2013
On July 30, 2012, CMS published a Proposed Rule that would make clear that a PCS for scheduled, repetitive non-emergency ambulance services carries no conclusive weight in determining medical necessity. The Rule also makes several technical regulatory changes regarding ambulance reimbursement. PWW is asking everyone in the EMS industry to comment on the Proposed Rule because it could have a significant negative impact on the industry.
OIG Report on Claims with G Modifiers
MAY 13 2013
The OIG recently issued another report: Medicare Payments for Part B Claims with G Modifiers, assessing how Medicare contractors are processing G modifiers and found that there are “vulnerabilities in how Medicare pays for these claims.” These “vulnerabilities” are resulting in improper payments of claims submitted with G modifiers. The report underscores the importance of using appropriate denial modifiers and tracking claims with G modifiers to make sure that Medicare is not improperly paying your agency for a service that should have been denied.