Air Ambulance Reimbursements See Renewed ScrutinyClarification of a policy change effective in January by the Centers for Medicare and Medicaid Services (CMS) could cost air ambulance companies in lost reimbursements and should put them on notice to document their work carefully.
Although air ambulances do not control when they are called to a scene, CMS reiterated its intention to withhold full reimbursement to air ambulance companies if, in the agency’s opinion, air transport was not required for the provision of quality patient care.
If an air ambulance transports a patient to a hospital and CMS officials do not think such transport was necessary, the air ambulance company could be reimbursed at the equivalent cost of ground transport. Additionally, if an air ambulance transports a patient to a hospital that is not the closest one, CMS may reimburse the company only for the equivalent cost of ground transport to the closer hospital if agency officials believe the closer hospital could have provided adequate services.
The reimbursement rates for air and ground transport differ dramatically, according to Kevin Hutton, M.D., FACEP. Hutton not only is chairman of the Association of Air Medical Services MedEvac Foundation International and an attending physician in emergency medicine at Scripps Memorial Hospital La Jolla in San Diego, but he is CEO of Golden Hour Data Systems, an information management and medical billing service that regularly works with CMS.
CMS payment for air transport is $4,500 while ground transport is reimbursed at $450, leaving air ambulance companies carrying a large bag if their claims are rejected, even in part. Suing CMS in court to appeal denials is prohibitive and won’t cover the money you might be paid for service if you win, says Hutton, unless companies can challenge denial patterns through a group of affected companies.
To protect their bottom line in this new economic environment, Hutton urges companies to maintain excellent documentation. “A lot of times it’s about documenting potential and judgment and the unique care provided in the back of the air ambulance,” he says. “The key mistakes people make are to make statements that negate medical necessity, that aren’t needed, like ‘Patient looked out the window and enjoyed the ride.’ The other thing is to document how you monitored the patient. Monitoring is important: the level of skilled care that was available, decisions you made or that you decided not to do.” Companies should especially point out how they tried to comply with CMS rules, but equipment and personnel were not available at the nearest hospital, Hutton adds.
See section 10.4.6 on the last page of the official CMS instruction, CR7161, posted online at cms.gov/transmittals/downloads/R133BP.pdf.
An Early Look at the 112th Congress
The mood in Washington, D.C., is one of fiscal conservatism, and if early congressional and executive actions are any indication, emergency responders seeking support and relief on the Hill certainly face a challenge.
As its first order of business, the new Republican-majority House of Representatives voted to repeal the health care bill signed into law in 2010 by a vote of 245 to 189, with three Democrats joining. While senators say the bill will not pass their house—and President Barack Obama would veto it if it did—House members have the ability to starve portions of this reform, and other funding proposals, by withholding payments through control of the budgetary process. For his part, the president placed himself at the forefront of fiscal reform by proposing annual domestic spending cuts and savings totaling approximately 12 percent during the next five years to reduce the swelling deficit.
Despite the focus on budget cutting, the administration agreed to fund one priority item on emergency providers’ wish list. Administration officials announced in January, before a public safety communications leadership group, that the White House not only supports the set-aside of the D Block portion of the radio spectrum for public safety organizations (see August and December 2010 Best Practices) but would seek more than $10 billion to fund the creation of a national public safety broadband network, according to Kevin McGinnis, MPS, EMT-P, who attended the meeting. (McGinnis consults on emergency communications issues and in November 2010 was elected chairman of SAFECOM, a program that recommends improvements to multijurisdictional and intergovernmental communications interoperability, administered by the U.S. Department of Homeland Security’s Office of Emergency Communications.)
Emergency responders active in recent years in establishing a Washington, D.C., strategy to build a permanent base of support for EMS issues have created a foundation, but much work remains to be done. “It is now up to EMS leaders at local, state and regional levels to get to the table first with the operational and medical apps they want to implement and take advantage of the money and bandwidth that will rapidly deplete as the nationwide public safety network builds its subscriber base,” McGinnis says.
Toward that end, the National Association of Emergency Medical Technicians (NAEMT) urges responders to go to Washington, D.C., May 3–4 for the second annual EMS on the Hill Day (see January and July 2010 Best Practices). Organizers hope to top the number of EMS professionals who converged on the nation’s capital last year (120 from 40 states and Puerto Rico) to ask their local representatives to support EMS issues. A schedule of events and registration information is at naemt.org/advocacy/emsonthehillday/EMSontheHillDay.aspx.
