The Department of Health and Human Services (HHS) issued a proposed rule today that would delay the ICD-10 compliance date until October 1, 2014. The delay is part of a larger proposed rule that would implement several new standards for electronic healthcare transactions. To view the official news release from HHS click HERE.
On November 29, 2010, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register the official Final Rule that will implement changes to many Medicare Part B payment policies, including the Ambulance Fee Schedule (AFS).
For all Medicare claims with dates of service on and after January 1, 2011, CMS states that ambulance services will be required to report mileage to the nearest tenth of a mile. The policy will apply to all claims with mileage up to 100 loaded miles. For example, if a Medicare patient was in the ambulance for 10.1 miles, the ambulance service would report 10.1 miles on the claim form, instead of rounding up to 11 miles (as CMS had previously instructed providers to do). CMS also states that ambulance services that track hundredths of miles should always round up the hundredths place. So, for example, if the tracked mileage was 1.43 miles, the provider would bill 1.5 miles.
All Medicare claims with mileage over 100 loaded miles will continue to be rounded up to the nearest whole number. For example, if the patient was in the ambulance for 100.3 miles, the ambulance service would report 101 miles on the claim form, as it had previously done. The new policy applies to both ground and air ambulance mileage and to both paper and electronic claims.
In the past CMS instructed ambulance services to round up mileage to the next whole mile (See, Change Request 1281, Transmittal AB-00-88, issued on September 18, 2000), because the claims processing system lacked the capability to process fractional mileage. The Final Rule states that that CMS’s system has now evolved to a point where rounding is no longer necessary. CMS also claims that the new policy will allow providers to more accurately report mileage and they believe that most providers have the capability to track mileage to the nearest tenth of a mile through odometers or GPS equipment.
CMS maintains that while the “basic digital odometer” in some ambulance models does not have record tenths, the “trip odometer” generally does. So, CMS clarifies that mileage may be measured using the “trip odometer” as well. With respect to providers that, for whatever reason, cannot currently track tenths of a mile, CMS states that they “believe that tools used to measure distance traveled (such as GPS navigation equipment) are readily available to the average consumer at a low cost.” According to CMS, such providers are “responsible for ensuring that they have the necessary equipment to measure fractional mileage to the tenth of a mile, and ensuring that onboard vehicle gauges measuring trip mileage are in working order.” Hence, CMS is now placing the burden on all ambulance services to obtain, and maintain in working order, equipment to track fractional mileage. Such equipment includes, but is not limited to: digital or analog odometers, trip odometers, GPS navigation, onboard trip computers or navigation systems.
Late this summer the legislature passed the FMAP contingency budget plan. This bill dealt with the possibility that federal FMAP funds would not cover a $1.085 billion budget gap. The federal government has earmarked $1.4 billion in enhanced FMAP and education funding and an additional $700 in Race to the Top education funding, which should have eliminated the need for the FMAP reductions. However, some of these funds have not yet made their way into the state coffers.
Therefore the State has enacted the FMAP contingency budget cuts. Effective September 16, 2010 most Medicaid providers, including Medicaid transportation providers, will see an approximate 1.1% reduction in their Medicaid payments. This reduction is scheduled to continue through the end of the state fiscal year, March 31, 2011. It is important to note that this is an across the board cut to not only transportation providers, but hospitals, nursing homes and other health and human service agencies.
We are hopeful that the Legislature will come back into session in the near future to allocate the federally earmarked funds and eliminate the need for this reduction to continue.
The Financial Plan Report is available for viewing at: