Bill Extending Ambulance Bonus Payments, Delaying ICD-10 Passes Senate

Last Minute Action

Bill Extending Ambulance Bonus Payments, Delaying ICD-10 Passes SenateWith reimbursement cuts looming for the ambulance industry today, The Senate voted 64-35 in favor of the Protecting Access to Medicare Act of 2014 (H.R. 4302) late last evening effectively delaying those cuts.

The bill now moves to President Obama’s desk for signing. It is anticipated the President will sign the measure without delay.

Passage of H.R. 4302 is good news for the ambulance industry, in the short term, as the bill extends the temporary payment adjustments (2% Urban, 3% Rural and the Super-Rural bonus) to the Medicare National Ambulance Fee Schedule that have been in place for several years.

These payment add-ons are now insured to extend for the remainder of the year.

ICD-10 Delay a Surprise

The surprise of the Act was the last minute delay of the conversion to ICD-10 diagnostic and procedure codes for another year.

Just one month ago, the Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner stated emphatically that there would be no extension to the coding change’s implementation. While the ICD-10 issue was not a focus of Monday’s floor debate over the bill, the provision was added and is seen to be a consolation prize to the physicians’ lobby who were dismayed over the failure of Congress to pass a permanent repeal of the Sustainable Growth-Rate (SGR) formula.

The ICD-10 transition has long been feared by American healthcare providers across all disciplines due to the level of specificity required in documentation to support claim coding for payment. Cynicism has been expressed by many, including those in the ambulance industry, who view the initiative as just another way for Medicare to justify denying payments.

Of course, given the fact that EMS providers cannot diagnose in the field yet ambulance claims are required to include a diagnosis code only added to the skepticism within the ambulance industry regarding the success of the transition from version 9 to version 10 of the coding discipline.

Ambulance industry concerns also include the cost to re-tool and train ambulance coders and providers alike on how to properly meet the compliance requirements, especially when little guidance has yet been given by insurance payers- most importantly CMS.

CMS Announces Delay

Given the uncertainty of whether or not Congress would fully pass the measure, CMS had already announced on Friday that it had instructed its Medicare Administrative Contractors (MAC’s) to hold claims paid under the Medicare Physician Fee Schedule for the first ten business days of April.

CMS explained that the delay was intended to give Congress time to pass the legislation that would further delay payment cuts, which now has happened but still won’t fully be enacted until the President signs the measure.

While the announcement didn’t specifically signal a delay in the processing of Medicare ambulance claims, given the fact that the temporarily adjusted payments were concurrently set to expire yesterday, it was anticipated that the 10-day delay would also most likely impact Medicare ambulance payments.

Now, with Congressional approval of the legislation a fact; it would seem that such a delay is unnecessary. However, we would not expect CMS to announce a reverse of their intentions to delay payments until President Obama signs the measure.

Stay Tuned…

As we learn how CMS will react given yesterday’s Congressional action, we’ll keep you posted on the potential impact to the ambulance industry.

In addition, while ICD-10 will now be delayed for an additional twelve months, it still only leaves us with a mere eighteen months to implement these rather sizeable changes. We strongly urge our clients to not delay informing your staff about the coming coding transition.

Your billing office needs to remain focused on ramping up toward implementation of the necessary changes needed to meet the ICD-10 requirements when they finally are put in place come October 1, 2015.

Enhanced remains committed to preparing for full implementation now, but certainly welcomes the extension in order that we can better assist in the education of our ambulance company clients.

We’ll continue to provide guidance and education using this blog space together with other forms of education and communication so our clients are fully prepared when the changes finally are required.

If your EMS department is not receiving regular updates and information about Medicare payments, ICD-10 or other important events that can impact cash flow, then maybe it’s time to connect with a billing resource that will keep you informed like we inform our clients.

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