Ambulance Fee Schedule Final Rule and Reimbursement Strategies

The United States Fire Administration (USFA), part of the Federal Emergency Management Agency (FEMA), is pleased to provide the following information module regarding the Centers for Medicare and Medicaid Services (CMS) Ambulance Fee Schedule Final Rule. Since its inception, USFA has been committed to providing information and technical assistance to local-level fire and EMS departments, and others in a wide variety of management and operational areas.

The new Ambulance Fee Schedule Final Rule has raised many questions among providers. This module provides timely information to improve understanding of the Rule’s requirements and present ideas for strategies that will assist departments in optimizing reimbursement within these requirements and limitations. The viewer will need the following programs to view the entire module: Adobe Acrobat 4.0 or greater and PowerPoint 2000. In the event that the viewer does not have PowerPoint, the module can be completed without it.

The module contains and overview of the history of Medicare, a description of Medicare Part B requirements applicable to ambulance providers, an explanation of the new Rule, methods and considerations for strategies to optimize reimbursement, and several helpful resource links. In addition, an Instructor Guide, Student Handout, and PowerPoint slide show covering the main points of the module is available through the Resources link for downloading and use by the department’s training division. The Instructor Guide and Student Handout files are provided in both Word 2000 and Adobe Portable Document Format (PDF) and are formatted for double-sided printing.

The viewer may read the module content in its entirety or use the links to access specific sections. Several sections contain internal links to other documents or self-paced activities. This module takes approximately 1 hour to complete. The Resources link provides access to other documents, additional useful web sites, and the PowerPoint slide show. The slide show takes approximately 15 minutes to view in its entirety.

Goal: The goal of this presentation is to provide a concise overview of the statutory requirements and coverage limitations of the Medicare Ambulance Fee Schedule Final Rule and strategies for optimizing reimbursement within these requirements and limitations.

Objectives:

  1. 1. Describe the historical development and programs administered by the Centers for Medicare and Medicaid Services.
  2. 2. Identify the requirements of Medicare Part B as they apply to ambulance suppliers, including:
    • Levels of Service
    • Medical Necessity
    • Physician Certification
    • Origins and Destinations
    • Vehicles and Staffing
  3. Explain the basic components used to determine the Medicare Ambulance Fee Schedule, including:
    • Relative Value Unit
    • Conversion Factor
    • Emergency Response Adjustment Factor
    • Operational Variations
    • Geographic Adjustment Factor
    • Inflation Factor
    • Mileage
  4. Describe the payment policies addressed in the Medicare Ambulance Fee Schedule Final Rule, including:
    • Billing Codes
    • Billing Method
    • Special Circumstances
  5. Guide the readers through an exercise to calculate the base rate for various levels of service for their local areas.
  6. Describe various methods and considerations for optimizing reimbursement of claims.
  7. Make available access to various resources to assist organizations in training personnel and facilitate the reimbursement process.

More information is available at
http://www.usfa.fema.gov/dhtml/fire-service/ambulance/intro.cfm

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