Fw: [abr] EMS LAW BULLETIN: Details of The Medicare Fee Schedule FINAL RULE

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[abr] EMS LAW BULLETIN: Details of The Medicare Fee Schedule FINAL

RULE

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> To Our EMS Clients and Colleagues:

>

> Page, Wolfberg & Wirth, LLC has obtained from Washington an advance copy

of

> the FINAL RULE for the Medicare Fee Schedule that is scheduled to be

> published in the Federal Register on February 27th. Here are the

> long-awaited final numbers and a brief summary of the major provisions of

> the final rule, scheduled for implementation on April 1, 2002.

>

> THE NUMBERS:

>

> The new conversion factor (base rate) for ambulance services is $170.54.

>

> The unadjusted base rate (UBR) numbers are as follows:

>

> BLS - $170.54

> BLS-Emergency - $272.86

> ALS1 - $204.65

> ALS1-Emergency - $324.03

> ALS2-$468.99

> SCT - $554.26 (Specialty Care Transport)

> PI - $298.45 (Paramedic Intercepts - applicable in certain areas of New

York

> only).

>

> LOADED MILEAGE: $5.47

> RURAL MILEAGE, Miles 1-17: $8.21

> RURAL MILEAGE, Miles 18-50: $6.84

>

> As in the Proposed Rule, the unadjusted base rates are adjusted based on

> your Geographic Practice Cost Index (GPCI) figures for your particular

area,

> so your actual base rate may vary somewhat from these figures.

>

> Other significant new developments in the Fee Schedule Final Rule:

>

> PHASE IN PERIOD EXTENDED TO 5 YEARS: There is now a FIVE YEAR phase-in

> period instead of a four-year phase in period as originally proposed.

> During the phase-in period, your payments will be determined by blending a

> portion of your existing payment rate with a portion of the fee schedule

> payment rate. The phase-in schedule is as follows:

>

> YEAR -- EXISTING PAYMENT % -- FEE SCHEDULE PAYMENT %

>

> 2002--80%--20%

> 2003--60%--40%

> 2004--40%--60%

> 2005--20%--80%

> 2006--100% fee schedule amount

>

> MANDATORY ASSIGNMENT: Assignment is mandatory under the new fee schedule.

> That means that you must accept the Medicare amount as payment in rull and

> may only bill the patient for unmet copayment and deductible amounts, NOT

> your full charges.

>

> MEDICAL NECESSITY: for payment to be made, the patient's condition must

meet

> medical necessity requirements for ambulance transport at the level of

> service billed (no more mandatory-ALS payments). For non-emergency

> transports, the patient must be EITHER (1) bed confined (under the current

> definition); OR (2) have a medical condition, " regardless of bed

> confinement, " such that " transportation by ambulance is medically

required. "

> Therefore, bed confinement is not the SOLE determinant of medical

necessity

> for non-emergency transports.

>

> PHYSICIAN CERTIFICATION STATEMENTS: Medicare has changed the rules for

> physician certification statements (PCS). Effective April 1, ambulance

> services must have a PCS form signed by the attending physician BEFORE

> rendering a nonemergency transport for a REPETITIVE PATIENT. For

> NON-REPETITIVE PATIENTS, and for UNSCHEDULED TRANSPORTS, the ambulance

> service must obtain a PCS FROM THE ATTENDING PHYSICIAN within 48 hours

after

> the transport. If the ambulance service cannot obtain a PCS from the

> attending physician, only then may the ambulance service obtain a PCS from

> physician assistant, nurse practitioner, clinical nurse specialist,

> registered nurse or discharge planner employed by the facility and with

> knowledge of the patient's condition. If the ambulance service cannot

> obtain the PCS within 21 days after the transport, it may submit the claim

> if it has documented its attempt to obtain the PCS. The documentation

must

> be a signed return receipt from the U.S. postal service OR similar service

> that evidences that the ambulance service made the attempt. Fax attempts

> are not specifically mentioned in the text of the final regulation. The

> presence of a PCS form does not conclusively mean that medical necessity

is

> met.

>

> BASIC LIFE SUPPORT DEFINITION: There was some confusion in the Proposed

Rule

> about including IV therapy in the basic life support payment. The Final

> Rule makes it clear that IVs are included in the BLS base rate ONLY in

those

> areas where EMTs may start IVs under state or local law.

>

> ALS1 DEFINITION: An ALS1 level of service is defined as including an ALS

> assessment OR the provision of at least one ALS intervention.

>

> ALS2 DEFINITION: An ALS2 level of service has been clarified to mean the

> administration of at least THREE different medications AND the provision

of

> at least one of the following procedures: manual defib/cardioversion;

> endotracheal intubation; central venous line; cardiac pacing; chest

> decompression; surgical airway; intraosseous line. Dextrose, normal

saline

> and Ringer's lactate are NOT medications for purposes of the " three

> medication " rule.

>

> EMERGENCY DEFINITION: The new definition of an " emergency response, " which

> qualifies for higher payment at the BLS and ALS1 levels, is " responding

> immediately . . . to a 911 call or the equivalent in areas without a 911

> call system. An immediate response is one in which the ambulance supplier

> begins as quickly as possible to take the steps necessary to respond to

the

> call. "

>

> We are certain that there will be more issues that will arise once a more

> comprehensive review of all of the fee schedule documents is completed.

> Nevertheless, these are the highlights. In addition, this information is

> taken from our advance copy of the Final Rule itself (not including the

many

> pages of Medicare's comments and the preamble to the actual Rule), and is

> subject to change depending upon the official publication of the Final

Rule

> in the Federal Register.

>

> Check our website, www.pwwemslaw.com, for a complete copy of the Final

Rule,

> which will be posted on February 27th on our web site's " Medicare Fee

> Schedule Resource Page. "

>

> Also, watch your e-next week mail for some special announcements regarding

> the HIPAA Privacy Rule.

>

> Page, Wolfberg & Wirth, LLC

> www.pwwemslaw.com

> A National EMS, Ambulance and Medical Transportation Law Firm

> 5010 E. Trindle Road, Suite 202

> Mechanicsburg, PA 17050

>

> (fax)

>

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