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).

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.

Some Ambulance Providers Could Potentially Still be Covered

Signed into law on December 18, 2010, the “Red Flag Program Clarification Act of 2010” (S. 3987) was intended by Congress to exempt certain organizations, like healthcare providers, from coverage under the Red Flag Rules. As a result of this new law, many ambulance services will no longer be covered under the Red Flag Rules, but, the language chosen by Congress did not grant an outright “exemption” for ambulance services or any other healthcare providers. Instead, the Act merely changed the definition of the term “creditor,” which could leave some ambulance services still covered under the Red Flag Rules.