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January 21, 2010

Medicare SUPER RURAL Bonus Payments End 1/01/2010
Other reduced payments include Urban -2% / Rural -3%

Arkansas ambulance providers will see reduced Medicare payments beginning January 1, 2010 due to expiring provisions in the Medicare Ambulance Fee Schedule and other MIPAA provisions. The largest payment reductions will be in those areas classified as SUPER RURAL where payment reductions will top more than 23%. Urban providers will receive a 2% reduction and rural providers a 3% reduction under the same provisions.

The ArAA and the American Ambulance Association continue to lobby for language that will restore the payments moving forward, but absent passage of the healthcare reform bill, no other legislative vehicle has been identified at this time. Please contact your representatives and encourage them to find a way to restore this vital EMS funding. As information become available, we will be asking our members to get involved and lobby for this most import cause.

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August 17, 2009

Medicaid Mileage Rate Increase Now In Effect

Providers should be seeing the new Medicaid mileage rate of $5.97/mile on current EOB's. The new rate is effective for dates of service 3/1/09 forward. Retro-adjustments will be processed in batches and there is no need to refile claims.

~~Arkansas Mediciad Mileage Rate Increase Effective July 1, 2008~~

~~STATUS UPDATE: Currently delayed by order of Gov. Beebe (continuing to monitor)~~

The ArAA continues to express our concerns and frustrations with hold placed on this vital help for Arkansas' EMS providers. This increase was part of a much larger Medicaid spending package that has yet to be funded by the Governor. We continue to work with the Governor's Office and senior staff members in an effort to move this initiative forward. 1/20/2009

DHS officials recently notified the ArAA that it intends to increase the ambulance mileage reibursement rate to 86% of the Medicare Ambulance Fee Schedule rate in effect on December 21, 2008. In effect, this will increase the ALS mileage rate from $2.97 per loaded mile to $5.52 per mile. Also, DHS plans to consolidate all mileage codes (BLS, ILS, and ALS) into one comprehensive code beginning January 2009. This increase is pending final CMS approval and more information will be forthcoming. Providers should not expect to see additional reimbursements until after final implementation steps have been concluded (perhaps as late as December 2008 or early January 2009.) Reimbursement will be retroactive to dates of service July 1, 2008 and beyond.

The ArAA extends its gratitude to Gov. Mike Beebe's office and staff, Rep. Joycee Dees and the team at the Arkansas Foundation for Medical Care (AFMC) for their assistance in moving this project forward.

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NPI UPDATE

Getting an NPI is free - not having one can be costly.

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ARKANSAS BCBS INCREASES PAYMENT FLOOR FOR AMBULANCE SERVICE
FROM $300 PER YEAR TO $1,000 PER YEAR FOR MOST PLANS

FROM AR-BCBS: Effective 04/04/06 the Ambulance benefit limitation will be changed to a $1000.00 benefit for services 04/01/06 and after. Transportation and mileage will be allowed at billed charges. All other charges for Ambulance will be subject to the fee schedule allowance. This will increase the members coverage for Ambulance services. If the member has already met the $300.00 benefit limitation for 2006, they will receive an additional $700.00.

The above message was transmitted to insurance agents on April 10, 2006. This is in response to ongoing negotiations with Arkansas BCBS to increase payments under many of its policies to better reflect the costs of ambulance services to its insured. This change represents a significant committment by BCBS to the ambulance industry. Many thanks to Bruce Hawkins, Ken Kelley, Jon Swanson and others for their diligence in this process.

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GAO Publishes Report on Medicare Ambulance Reimbursement
Costs and Expected Medicare Margins Vary Greatly

Costs of ground ambulance services were highly variable across providers that did not share costs with nonambulance services in 2004, reflecting differences in certain provider and community characteristics. Costs per transport among these providers varied from $99 per transport to $1,218. Providers without shared costs that had higher costs per transport typically had fewer transports per year, a greater percentage of transports in which more than a basic medical intervention occurred, more transports in super-rural areas (rural counties with lowest population density), lower productivity—measured as number of transports furnished per staffed hour, and a greater percentage of revenues from local tax support. Average payments under the national fee schedule in 2010 are expected to be higher than historical payments, but providers’ Medicare margins will vary greatly. GAO could not assess whether, on average, providers without shared costs would break even, lose, or profit under the national fee schedule, because the average Medicare margin for providers without shared costs was estimated to fall from negative 14 percent to positive 2 percent. However, GAO estimated that approximately 39 to 56 percent of providers without shared costs would have average Medicare payments above their average cost per transport under the national fee schedule in 2010. From 2001 to 2004, utilization of ambulance transports per beneficiary increased 16 percent overall. However, use declined by 8 percent in super-rural areas. Declining utilization coupled with potentially negative Medicare margins in super-rural areas, which could be exacerbated when the MMA temporary payment provisions expire, raise questions as to whether Medicare payments will be adequate to support beneficiary access in super-rural areas.