Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services' tardiness in implementing a national fee schedule for ambulance services could result in a windfall for medical transport companies. Under federal law, CMS was required to provide fee schedule payments to ambulance companies starting Jan. 1, 2000. But the agency didn't get final fee schedule in place until Feb. 27, 2002 - and the schedule didn't include any provisions for retroactive payments. Ambulance suppliers fought back, sued CMS, and persuaded a federal judge to order the agency to establish a fee schedule for Jan. 1, 2000 up to the effective date of its Feb. 27, 2002 fee schedule rule. CMS got that process rolling April 16, outlining its plans in the Federal Register. The Bottom Line: Ambulance suppliers are looking at $81 million in additional Medicare payments to cover the period neglected by CMS' previous fee schedule. That figure includes about $16 million in additional mileage fees for ambulance companies in North Carolina and Tennessee, as mandated by a federal law passed in 2000. CMS warns that it is appealing the case, and that, if it prevails, any payments made under the retroactive fee schedule will be subject to recoupment. To see CMS' notice, go to www.access.gpo.gov/su_docs/fedreg/a030416c.html. CMS also invited public comments on a variety of information collection activities, including: evaluation of the Illinois and Wisconsin state pharmacy assistance waivers;
the third party premium billing request;
the Ticket to Work and Work Incentives Act demonstration to maintain independence;
the Medicare Lifestyle Modification Program demonstration;
refinement of the RHC Certification and QAPI and supporting regulations in 42 CFR 491.9 and 491.11;
the request for termination of Premium+ Hospital and/or Supplemental Medical Insurance;
the request for enrollment in Supplemental Medicare Insurance;
the Medicare waiver demonstration application;
conditions of coverage of suppliers of end stage renal disease;
and information collection requirements in the hospice conditions of coverage.