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REGULATORY UPDATE

MARCH 23RD, 2018
CMS issued CR 10531: Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018.  You can download the Change Request here.  Among the provisions, MAC's can make payment adjustments for claims starting January 2018 for 2 and 3%'s after April 2nd of this year.  You can visit the CMS page here.
 

CGS MEDICARE UPDATE

MARCH 1ST, 2018
OAMTA has received the following update from CGS Medicare: A widespread issue affecting the common working file (CWF) resulted in payment demand letters and payment denials to some providers.  CWF files have been fixed as of 03/01/2018. Although it is unclear when adjustments will be made, CGS will make all adjustments. The information below is also available through the CGS Claim Issue site. 
 
 
Line of Business: Part B

Provider Type Impacted: Ambulance and Physician's Professional Services

Description of the Issue:  Change Request (CR) 10262 addressed the January 2018 CWF update to Skilled Nursing Facility (SNF) Consolidated Billing edits. Changes to the editing inadvertently are causing claims for non-therapy, ambulance services to or from dialysis facilities and physicians professional services to deny in error Refer to MM10262, the Internet Only Manual Publication 100-04, Chapter 15, Section 30.2.0 and 100-04 Chapter 6, Section 80 for additional information.
 
 
Action Required by the MAC
All claims affected will be adjusted by the MAC (this would include claims that were setup for take backs)
 
Claim Coding Impact (i.e. HCPCS, ICD code etc):
 
Ambulance Services: An Ambulance Supplier may bill Medicare Part B for a beneficiary who is in a SNF, has ESRD and requires Part B dialysis services and is transported by ground ambulance to or from the nearest appropriate hospital based or non-hospital based ESRD facility.
 
Physician Services:  The professional component of a facility-based physician's services includes services directly related to the medical care of the individual patient. SNFs cannot bill for the professional components of the physicians services, these must be billed under the physician provider number to Medicare Part B.

 
 
Beneficiary in a Part A Covered SNF Stay: These codes are not subject to SNF Consolidated billing.  They should be submitted to the Part B Medicare Administrative Contractor for payment consideration. 
 
 
HCPCS
SHORT DESCRIPTOR        
 
A0425
Ground mileage
           
 
A0426
Als 1
             
 
A0427
ALS1-emergency
           
 
A0428
Bls
             
 
A0429
BLS-emergency
           
 
A0430
Fixed wing air transport
         
 
A0431
Rotary wing air transport
         
 
A0432
PI volunteer ambulance co
         
 
A0433
Als 2
             
 
A0434
Specialty care transport
         
 
A0435
Fixed wing air mileage
         
 
A0436
Rotary wing air mileage
         
 
A0999
Unlisted ambulance service

 

FEDERAL UPDATE

 
FEBRUARY 12TH, 2018
On Friday, Congress passed the 5 year extension of the Medicare ambulance add-ons. The extension was part of the two-year budget deal reached by congressional leaders and passed by the Senate and the House. The ambulance provisions in the final deal differ from the provisions passed earlier by the House in one key area - the collection of ambulance cost data. This means that we are truly in the endzone of the add-on payment extension process.  We'd like to recognize Julie Rose, our immediate past president, for her incredible hard work and determination in advocating on this issue before Ohio's Congressional delegation.
 
Here are the specifics of the final package:
  • 5 year extension of the ambulance Medicare add-ons through December 31, 2022, retroactive to January 1, 2018.
  • AAA's preferred method of Cost data collection that provides flexibility to the Secretary of HHS in developing the system. Consultation with the industry is required so that it strikes the appropriate balance between obtaining meaningful data while not overly burdening or onerously penalizing the ambulance services.
  • The penalty for failing to report required data would be a reduction in payment up to 10% for the year following the year in which the data should have been submitted. AAA objected to the house proposed penalty of up to a year of Medicare payments clawback or withholding of payments. A clause is included to wave the penalty in cases of hardship.
  • A "pay-for" for the 5-year extension of the add-ons with a 13% cut to non-emergent dialysis transports - the AAA had objected to the offset and pushed for a cut targeted to just those entities which abuse the dialysis transport benefit. We were successful in reducing the initial cut from 22% to 13%. The AAA is actively working on other pay-for options that would replace the 13% cut with something targeting dialysis fraud and abuse.

 

FEDERAL UPDATE

 

FEBRUARY 7TH, 2018
Yesterday, the U.S. House of Representatives passed legislation which includes a five-year extension of the Medicare ambulance add-ons. The House voted 245 to 182 to pass a Continuing Resolution (CR) to fund the federal government beyond the current expiration date of February 8. The CR included a package of Medicare provider extenders including an extension of the temporary Medicare ambulance add-ons.
The ambulance provisions in the CR include the following:
  • A five-year extension of the temporary Medicare ambulance increases of 2% urban and 3% rural to base and mileage rates and 22.6% to the base rate in super rural areas. The extension would be retroactive to January 1, 2018 and expire on December 31, 2022.
  • The requirement for ambulance service suppliers to submit cost reports. The language is based on H.R. 3729 as reported by the House Ways and Means Committee but with new language providing the CMS Administrator with the discretion to apply a payment suspension or overpayment as the penalty for suppliers that do not submit timely, accurate and complete data after the initial two years.
  • To offset the cost of the add-ons extension, a further reduction of 13% in Medicare reimbursement for BLS non-emergency transports to and from dialysis centers. The initial reduction was 22% but the AAA was able to help lower the estimated cost of the add-ons and thus lower the percentage of the offsetting cut.
The CR now goes to the Senate for its consideration. Thanks to OAMTA Board Member and Immediate Past President, Julie Rose, for her hard work and advocacy on this issue.