HomeMy WebLinkAbout(1.5) AMBULANCE PRESENTATIONBACKGROUND:
The Balanced Budget Act of 1997
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(BBA) required the Centers for
Medicare & Medicaid Services (CMS)
to replace its current ambulance
payment methodologies with a
national fee schedule to be
developed through negotiated
rulemaking.
CURRENT PAYMENT
PROCEDURES
Currently payment for ambulance services is
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based on "reasonable charges" for
independent suppliers and "reasonable
costs" for provider-based services.
Reasonable charge payments are based on
historic local charging patterns throughout
the service area. The reasonable charge for
a BLS ambulance call staffed with a
paramedic is $267.46. The new fee schedule
amount will be $170.54 for the same service.
After regional modifiers are applied the actual
reimbursement is $156.21.
FINAL RULE ADOPTED
A final ambulance regulation was
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adopted and was published February
27, 2002 in the Federal Register. It
went on display in the Office of the
Federal Register and phased-in
implementation will begin April 1,
2002.
Seven New Categories of
Ground Ambulance Services
Ground Transport Fees
BLS $170.54
BLS-Emergency $272.86
ALS1 $204.65
ALS1-Emergency $324.03
ALS2 $468.99
SCT $554.26
Paramedic Intercept * *$298.45
Loaded Mileage: $5.47
Rural Mileage: miles 1-17: $8.21
Rural Mileage: miles 18-50: $6.84
* Only applicable in certain areas of rural New York
MEDICAL SUPPLIES
NOT COVERED
Under the new fee schedule medical
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supplies are “ now ” to be included in
the base rate. Additional fees will
not be paid for supplies used.
Currently additional fees are allowed
for medical supplies, which average
$21 per ambulance call.
PAYMENT BASED ON
CONDITION OF PATIENT
The level of service to be paid will be
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based on the condition of the patient , not
the level of personnel providing the
service . A patient who only needs a BLS
assessment and treatment will by paid at
the BLS rate even if a local ordinance
mandates ALS on every ambulance.
MULTIPLE PATIENTS IN
SAME AMBULANCE:
When two patients are transported in the
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same ambulance Medicare will allow 75
percent of the fee and 50 percent of the
mileage for each Medicare beneficiary. For
three or more patients transported in the
same ambulance, Medicare will allow 60
percent of the fee for each beneficiary and
mileage to be prorated equally among the
number of patients.
IMPLEMENTATION
AND PHASE-IN
The final rule provides for the fee
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schedule to begin on April 1, 2002
with a 5-year phase-in.
Financial Impact
of Fee Schedule
Total calls affected – Non emergency transports – 663 per
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month in PA
Lost income from Supplies @ $21 per call = $13,923 per month
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in PA
Lost income from non emergency transports:
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Year 1 lost revenues - $14,751 plus $13,923 = $28,674 per month
Year 2 lost revenues - $29,503 plus $13,923 = $43,426 per month
Year 3 lost revenues - $44,253 plus $13,923 = $58,176 per month
Year 4 lost revenues - $59,004 plus $13,923 = $72,927 per month
Year 5 lost revenues - $73,755 plus $13,923 = $87,678 per month
EMERGENCY TRANPORTS
Emergency Transports will have a
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lesser impact than the non
emergency transports.
Approximately fifteen percent of our
transports qualify as an emergency.