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CMS Issues Proposed Rule Affecting Scheduled, Repetitive PCS Forms

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. 
 
These changes are part of a...

HHS Publishes Final HIPAA II Regulations

On January 25, 2013, the U.S. Department of Health and Human Services (HHS) published a Final Rule implementing sweeping changes to the Health Insurance Portability and Accountability Act (HIPAA). This “Omnibus” Rule combines four different rulemakings and makes final a number of long-awaited proposed changes to the HIPAA regulations.  The bulk of the changes concerning the ambulance industry center around regulations proposed under the Health Information Technology for Economic and...

FAA Final Rule Creates Stricter Safety and Equipment Regulations for Helicopter Air Ambulance Operations

New rules from the Federal Aviation Administration (FAA) will have a significant impact on helicopter air ambulance services.  These regulations implement new operational procedures and require additional equipment for helicopter air ambulances in response to an increase in fatal helicopter air ambulance accidents.  The new rules identify four common factors in those accidents- inadvertent flight into Instrument Meteorological Conditions, loss of control, controlled flight into terrain, and...

Novitas Releases New LCD - Affects Medicare Part B Payments for PA, MD, DE, NJ and DC Ambulance Services

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. It is available HERE. The LCD establishes new payment procedures that now require ambulance services to...

CMS Issues Proposed Rule on Reporting Overpayments

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”). To access a PDF copy of the Proposed Rule click HERE. You may also submit comments to the Proposed Rule by going to...

All Medicare Contractors Must Soon Process Codes for Non-Covered Services

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...

Retroactive Payment for Ambulance Services

CMS Announces Plan for Retroactive Bonus Payments

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

CMS Publishes Final Rule on Fractional Mileage

On November 29, 2010, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register the official Final Rule that will implement changes to many Medicare Part B payment policies, including the Ambulance Fee Schedule (AFS).   The published version of the Final Rule mirrors the advance copy obtained by PWW on November 2nd.  
 

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CMS Changes Stance Regarding Coverage of Transportation Services Under Certain State Medicaid Plans

Ambulance services have a reason to breathe a little easier today because CMS has backed off on a Final Rule that would have allowed states to amend their “benchmark” and “benchmark equivalent” Medicaid plans to exclude coverage of non-emergency transportation. A revised Final Rule, issued April 30, 2010, now expressly requires states to assure necessary transportation to and from providers for all beneficiaries enrolled in benchmark or benchmark-equivalent Medicaid plans.  ...

CMS Final Rule Regarding Ambulance Signature Requirements

In November 2008, Medicare released the Final Rule that contains more changes to the beneficiary signature requirements contained in 42 CFR §424.36. The rule becomes effective on January 1, 2009.
 
Summary of the Final Rule
 
PWW's summary of the changes of the final rule are as follows: 

·        CMS did not adopt the proposed language at 42 CFR §424.36(a) that would have required...

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