Sweeping changes and budget cuts on Capitol Hill cause Medicare and Medicaid provisions for coverage of both emergency and non-emergency ambulance transport to be susceptible to change. Most recently, on March 23, 2010, the Patient Protection and Affordable Care Act was signed into law by President Obama. With this law, certain coverage provisions were changed or extended that all ambulance and medical transport business owners should be aware of.
Medicaid Reimbursement Increases
Initial discussions of ambulance coverage under new Medicaid provisions hinted that all non-emergency ambulance transports might be excluded, or left up to states to decide according to a proposed provision called the Final Rule. The Final Rule was set to take effect, but that date never came to pass, and ambulance business owners were happy to learn that non-emergency ambulance transport services are still covered and protected by explicit language, even after the signing of the PPACA.
With the signing of the PPACA, ambulance fee schedule amounts for transports occurring for covered reasons that originate in rural areas will increase by 3%. The same for transports originating in urban areas will increase by 2%. Both changes are retroactive to January 1, 2010.
Medicare & Medicaid Coverage Provisions
According to the Centers for Medicare and Medicaid, current reimbursement provisions for covered ambulance transport are largely unchanged, with the latest formal change announcements dating back to 2007. As coverage levels currently stand, patients can expect reimbursement and coverage for emergent medical issues only.
Medicare Part B offers coverage for patients needing ambulance transportation to or from a hospital and skilled nursing facilities, only in instances when other transportation could endanger patient life or health. In some instances, exceptions may be made on a case by case basis. For example, patients with End-Stage Renal Disease are often afforded ambulance transportation to facilities that provide dialysis.
Medicare will provide coverage for incidents and accidents that place patients in serious danger, and when time is of the essence. If a patient requires restraint, medical treatment en route, or is in severe pain, shock or is unconscious, Medicare will offer coverage for ambulance transport. In these instances, Medicare will cover transport to the nearest medical facility. If patients request to go to a hospital other than the closest facility, Medicare will only cover the transportation portion equivalent to transport to the nearest facility, and the remainder will be an out-of-pocket expense to the patient. However, if a patient needs a specific facility to treat their condition, and that facility is not the closest, Medicare will cover transport.
Ambulance business owners, or investors considering purchasing an ambulance transport business should always keep abreast of changes in Medicare and Medicaid language in order to prevent incurring expenses that are not reimbursable.