On July 7, 2008, the Centers for Medicare and Medicaid Services (CMS) published a Proposed Rule in the Federal Register that would make further modifications to the Medicare signature rules for ambulance services.  The Proposed Rule contained several other provisions that would also affect ambulance services.

 

 

CLICK HERE for the relevant excerpts of the July 7, 2008 Proposed Rule (14 pages, PDF format)

IMPORTANT: Please note that these latest proposed regulations are not in effect; until further notice all ambulance services must continue to adhere to the existing signature regulations, effective January 1, 2008, contained in 42 C.F.R. § 424.36. CLICK HERE for PWW’s summary of the current regulations.

 

 

As discussed on page 38580 of the Proposed Rule (which you can download above), CMS is proposing new language to 424.36(a) - the “general rule” - to “clarify” that before ambulance services may rely on the signature of one of the authorized signers (such as a legal guardian or POA), they must first “make reasonable efforts to obtain the signature of the beneficiary.”  CMS does not define what it means by the term "reasonable efforts." 

Also discussed on page 38580 of the Proposed Rule is Medicare's proposal to expand Section 424.36(b)(6) - which created an additional exception to the beneficiary signature requirements for “emergency ambulance transport services” - to non-emergency services as well.  

CMS also proposes to amend the regulations to clarify that a signature “on the claim” does not mean that the signature actually has to be on the claim form itself, but that it could also be on a form that contains adequate notice that the purpose of the signature is to authorize a provider or supplier to submit a claim to Medicare for services, such as utilized in PWW’s model signature forms, released in January 2008 following implementation of the current signature rules.  This is essentially clarification of current practice since patients and authorized signers rarely sign the actual “claim forms” anyway. 

GPCI Changes: CMS is also proposing to modify the 2009 "Geographic Practice Cost Index" portion of the Medicare Physician Fee Schedule (PFS).  A portion of the PFS GPCI (the "Practice Expense" portion) affects the calculation of ambulance reimbursement rates under the Medicare Ambulance Fee Schedule (PFS).  These proposed 2009 GPCI figures are contained on pages 38829 - 38831 of the Proposed Rule, which you can download by clicking the link above.

Appeals of Medicare Billing Privileges Decisions: CMS is also proposing to make some modifications to its recent Final Rule regarding appeals of decisions by Medicare contractors regarding a provider or supplier's Medicare billing privileges.  These new proposed modifications to those regulations would make revocation of a provider or supplier's Medicare billing privileges effective on the date of Medicare exclusion, debarment, felony conviction or suspension or revocation of the provider or supplier's license.  These proposed changes are discussed on page 38581 of the Proposed Rule, which you can download by clicking the above link.

Bonus Payments for Long Distance Ambulance Transports:  As discussed on page 38578, CMS also issued a "reminder" in the preamble of the Proposed Rule that the temporary 25% bonus on loaded miles in excess of 50 is due to expire after December 31, 2008.  With the surge in fuel prices, this is certainly a cut that will be felt by ambulance services that regularly perform transports in excess of 50 miles.

 

CLICK HERE to download a copy of the letter that PWW submitted to CMS on the Proposed Rule (PDF format).

 

 

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