The EMS attorney firm Page, Wolfberg and Wirth shared on the afternoon of April 1, the White House reported the President just signed a bill extending the Medicare ground ambulance bonus payments until March 31, 2015 and delaying the implementation of ICD-10 codes until at least October 1, 2015.   

 

This means that the 2% urban, 3% rural and 22.6% super-rural bonuses that were set to expire on March 31, 2014 will remain in place for another year.  Ambulance services should not see any interruption in these bonus payments.  In addition, the ambulance industry now has until at least October 1, 2015 to prepare for the transition from ICD-9 to ICD-10 code sets. 

 

H.R. 4302 provides temporary relief to certain providers while Congress considers a more permanent fix to combat rising Medicare costs.  In the meantime, ambulance services are already exploring new delivery models and considering non-traditional revenue sources in order to be successful in the healthcare reform era. 

 

This delay does not mean sit and wait another year.  ICD-10 codes are coming and now is the time to get prepared for ICD-10 compliance and to use this delay to get ready - like training your crews to be more focused on "specificity" in patient care documentation - which will take time to do.

 

Source:  Page, Wolfberg and Wirth EMS Attorney Firm

 

ICD-10:  What is it?

The Professional Ambulance of Wisconsin completed an interview in 2012 that is relevant today yet regarding a forthcoming change from ICD-9 to ICD-10, and what this change means for those who write patient care reports and do the billing.  ICD-10 increases the EMS billing codes by several thousand and places significant emphasis, or "specificity", on patient care reports.  Click here to listen to the interview PAAW previously completed on this topic.

On March 28, the Centers for Medicare and Medicaid Services (CMS) announced that it had instructed its Medicare Administrative Contractors to hold claims paid under the Medicare Physician Fee Schedule for the first 10 business days of April (i.e., through April 14, 2014).
 

CMS indicated that this delay was necessary to prevent implementation of a negative update (i.e., a cut) to the physician fee schedule that was scheduled to take effect January 1, 2014.  However, the passage of the Pathway for SGR Reform Act of 2013 delayed the implementation of that payment reduction through March 31, 2014.  CMS indicated the most recent delay was intended to give Congress time to pass additional legislation that would further delay these cuts.

While the announcement did not specifically mention a delay in the processing of Medicare ambulance claims, the temporary adjustments for ground ambulance (urban (2%), rural (3%), and the super-rural bonus) are also currently scheduled to expire on March 31, 2014.  Therefore, ambulance services should be aware that this delay may also impact the processing of ambulance claims.

 

Source:  American Ambulance Association

Large Volume IV Fluids Supply Update

IV bags continue to be on a nationwide shortage.  To make matters worse, this week Baxter cancelled all existing backorders and reduced their allocation quantities.  "These two action steps by Baxter will have  a notable negative impact on what is already an extremely strained supply chain", according to Stacey Barksdale Price, Product Manager of IV Therapy and Pharmaceuticals at Bound Tree Medical, the nation's largest EMS product dirstributor.

The American Society of Health-System Pharmacists (ASHSP) recently shared the Intravenous solution conservation strategies document attached.   Barksdale Price noted, "Be encouraged by the May / June relief timeline that is mentioned in this document.  We are seeking to understand the remedial efforts taking place at the manufacturing level that supports that resolution timeline.  As more information is available, we will be sure to keep you updated."

To view the latest backorder report, click here.

To listen to an EMS to the Point audio interview with Stacey Barksdale Price regarding the ongoing IV fluids and EMS pharmaceutical backorder problem, click here.

The American Ambulance Association released on March 10 its 2014 State Medicaid Rate Survey results.  During the past few weeks, members of AAA’s Medicare Regulatory Committee researched the Medicaid rates paid to ambulance service providers in every state, and consolidated that information into a single reference guide.

With this year’s Rate Survey, the Committee also added a chart showing the status of crossover payments for dual-eligible patients (i.e., beneficiaries with both Medicare and Medicaid).

Federal Medicaid monies are distributed to each State, and each State is responsible for establishing a Medicaid rate paid for modes of transportation to cover its insured beneficiaries, to include ambulance transportation.

Below is a chart showing Wisconsin’s Medicaid ambulance rate and that of surrounding states from AAA's Medicaid Rate Survey.

STATE	BLS	ALS	ALS-2	PER MILE	OXYGEN	SUPPLIES
Wisconsin	$94.90	$113.88	$260.97	$5.56	$14.73	$14.73
Illinois (Lake County)	$127.34	$198.49	$198.49	$5.00	$15.05
Iowa	$69.98	$113.29		$2.16	$10.79	$4.32
Michigan	$105.32	$191.88	$191.88	$3.27
Minnesota	$206.33	$250.06	$573.13	$6.97

Prior to having knowledge of the AAA Medicaid Rate Survey, the Professional Ambulance Association of Wisconsin’s Board of Directors on January 9, 2014 identified Wisconsin’s Medicaid rates as an area of concern.  Wisconsin ambulance providers have not received a Medicaid fee increase in many years.  PAAW established a committee to further discuss Medicaid rates, with one potential idea being reimbursement that matches the Federal Medicare fee schedule.

PAAW also completed a webcast interview in advance of the AAA State Medicaid Rate Survey being announced.  To listen to the interview with Tristan North, Senior Vice President of Government Affairs for the AAA in Washington DC, click here.

AAA members may log-in to view the 2014 State Medicaid Rate Survey by clicking here.

Source:  American Ambulance Association

Both Ford and GM, the primary producers of chassis for our industry, will be producing fewer chassis for ambulance production in calendar year 2014.

The slowdown has already started at Ford, where a V-10 engine commodity problem has curtailed the availability of Econoline 6.8L vans and cutaways so far this year.  Many ambulance manufacturers are reporting they are virtually out of both models, and that new chassis will be scarce for the foreseeable future.

The shortage will escalate in June, when Ford cutaway (Type III) production is shut down for 6 weeks due to a plant modification. In addition, the venerable Econoline van, long the workhorse of our industry, will be completely discontinued at that same time.  It will be replaced by the new Ford Transit as part of Ford’s global plan.

Industry sources state that the Transit startup in a new Ford plant will be slower than planned, and that the gas powered Transit vans with the required ambulance package are not expected to be available until early calendar 2015. Diesel powered Transit vans may be available slightly earlier.

GM is also making some moves that will affect the supply of their ambulance chassis in 2014.  A start up of production for a new mid-size pickup in the same GM plant that produces the G series vans and cutaways will reduce the production of those models by approximately 50% in the second half of calendar 2014.  GM does not have any significant changes in their ambulance chassis models scheduled in the short term.

Supplies of Ford F cab chassis, Sprinter, International, Freightliner and Ram ambulance chassis appear to be normal, and no shortage is anticipated in those models at this time.

Source: American Ambulance Association

To read the long version of this memo officially released by the Wisconsin EMS Office, click here.

The mission of the Wisconsin Emergency Medical Services (EMS) program is to ensure that the highest quality and standards of pre-hospital emergency medical care are available to all Wisconsin citizens and visitors.  To operate as an EMT or Emergency Medical First Responder, one must be licensed with the State of Wisconsin and credentialed with an ambulance service.

The 2014-2016 Provider License Renewal application is now available online through individual E-Licensing accounts. The Renewal application must be completed by June 30, 2014, in order to obtain a current certification or license that is valid until June 30, 2016.  All current Wisconsin EMS provider licenses and certifications expire on June 30, 2014.

Important renewal dates to remember for 2014-2016:

November 1, 2013 through June 30, 2014 is the standard renewal period.

July 1, 2014 through December 31, 2014 is the late renewal period.

January 1, 2015 through June 30, 2016 is the reinstatement period.

A license or certification that has been expired for two years or more may only be reinstated by successful completion of the initial education, training and examination requirements.

As an EMS provider applicant, you will need the following information to complete the 2014-2016, EMS Provider Renewal Application on the E-Licensing system:

• Your initial or continuing EMS education refresher training completed between July 1, 2012 and June 30, 2014;
• Your current CPR card; and
• Whether you were convicted of a felony or misdemeanor, or deferred prosecution, since your last application, or have pending charges at this time, or received a traffic violation that led to the suspension, revocation or withdrawal of your driver's license, and all required court documentation. (You will have the opportunity to upload the documents if you have them electronically.) If you cannot upload your documents into the application, you should email them to the Wisconsin EMS program at dhsemssmail@wisconsin.gov or fax them to 608-266-6391.

2014-2016, renewal instructions by provider level
2014-2016, First Responder Renewal Instructions
2014-2016, EMT Basic Renewal Instructions
2014-2016, EMT Intermediate Technician /AEMT Renewal Instructions
2014-2016, EMT Intermediate Renewal Instructions
2014-2016, EMT Paramedic Renewal Instructions
2014-2016, EMT Paramedic with Critical Care Endorsement Renewal Instructions

Besides delivering EMS care to a community, two of the most important business responsibilities an ambulance manager has is obviously billing for services provided and daily sales outstanding (the number of days from the patient being transported to the ambulance service actually being paid).  Topping the list for many is the fee structure paid by Medicare (Federal), Medicaid (BadgerCare at the State of Wisconsin), and now the Affordable Care Act through health insurance exchanges.

These three important areas are discussed in this newest webcast with Tristan North, Senior Vice President for Government Affairs at the American Ambulance Association in Washington, D.C.

Two items covered in the webcast are worth noting:

1. A current study is being completed to compile a ranking of state Medicaid rates paid to ambulance services.  We know Wisconsin ranks low in rates paid for BLS and ALS patient transportation; however, the final results will be telling.
2. The Affordable Care Act appears to offer insurance plans that cover many hospital charges, but not ambulance transportation.  The greater concern is some of these plan options have much higher deductibles in the thousands of dollars, possibly changing the payer mix to more self-pay patient transports.  This may put an ambulance service more at risk for not getting paid for 911 and other call out requests in serving the public's emergency or medical needs.

To listen to the webcast, click here.

The EMS Leadership Academy is a dynamic, four-level, 60-hour educational program designed to prepare persons to lead and manage today’s EMS organization. It is designed to give participants the basic tools and information needed to quickly and successfully assume or be in the role of an EMS leader.  The program series is underwritten and sponsored by the Wisconsin Office of Rural Health.

Since 2009, more than 900 leaders across the nation have participated in the Academy, many from Wisconsin during the past couple of years.

Each level is a 15-hour, two-day program presented on consecutive days in comfortable settings that invite participation and openness.  Class size is limited and the sessions are engaging, lively and participatory.

Each course is two-days and costs only $40 - inclusive of both days.  Meals and refreshments are included.  Please note that the levels need to be taken in order.  The previous level is a prerequisite for the next. 

Click here for the program brochure and outline.

Register on-line at: https://charge.wisc.edu/ruralhealth/workshops.asp

Level One
March 15-16, 2014
Marshfield Fire and Rescue Dept., Marshfield, WI

Level One
April 24-25, 2014
Green County EMS, Monroe, WI

Level Two
April 26-27, 2014
Green County EMS, Monroe, WI

Level Three
July 26-27, 2014
Lemonweir Valley Phone Company, Camp Douglas, WI

Level Four
August 16-17, 2014
Three Bears Lodge, Warrens, WI  

For additional information or if you have a question, contact:  Kathryn Miller, Program Manager, Rural Hospitals & Clinics Program, Wisconsin Office of Rural Health, Phone: 608-261-1891.