One Last Look at Ambulance Billing in 2014- What’s Next?

You Deserve a Break!

We’re going to make this our last blog post for 2014. You deserve a break!

One Last Look at Ambulance Billing in 2014- What’s Next?But before we sign-off to celebrate the season, we thought we’d take a moment to reflect on the year that’s been just one last time. Let’s take a look at what we’ve been through together and then look ahead to what 2015 will bring.

The Power of the E!
We’ve enjoyed this year, here at Enhanced. When the calendar rolled over to 2014, we rolled out the ambulance billing industry’s first-ever mobile App. The Power of the E! App combined all of our communication channels into one easy-to-use mobile experience and provided our clients with the ability to access data right from any mobile device.

Your feedback has been very positive!

Bonus Payments

Congress gifted us in March by extending the Medicare bonus payments for another year. While this was really good news, what will 2015 bring?

A new Congress will be ushered in this year, one with starkly different ideological DNA. Will they once again extend the payments or will be finally see them fix this payment nightmare once and for all?

Zip Code Changes…the Rural to Urban Slap in the Face!

And…while we’re on the subject of bonus payments, unless CMS gifts us all with a big announcement in the next thirteen days, it appears that many of us who have enjoyed the rural bonus payments will now lose one percent of our base rate payments, but more hurtful we’ll also lose a whopping fifty percent in mileage add-ons for the first seventeen miles of a transport.

Over 3,000 currently rural zip codes will be re-classified as urban and the result will be slimmer payments for EMS agencies that really can’t afford to lose any more revenue.

All this is just another reason why Congress needs to help out the ambulance industry and fix this payment mess once and for all. Or…slowly the ambulance industry in America will be forced to do more with less once again!

More Medicaid Adds to Payer Mix Shuffle

Multiple millions have been added to the Medicaid roles in 2014, thanks to the growing after-effects of the dawn of the Affordable Care Act.

Of course, while we’re whining about payments the additional Medicaid recipients who now have some coverage have nowhere near the coverage amounts that our industry needs to adequately offset growing costs to provide the service. Plus with so many physicians unwilling to serve Medicaid patients, the Medicaid population is using EMS as an entry way into receiving care at already over-staffed hospital emergency departments.

While we’re glad more people have insurance coverage, if that coverage is paying us fewer dollars that don’t come near to covering our costs then one must ask is it really any good or does it simply make the powers-that-be feel good that they provided something that looks pretty on paper?

Plus more and more people have lost good healthcare coverage from commercial insurance plans impacting the ambulance industry by reducing payment levels as people move from higher-paying plans to more affordable premium plans that carry huge annual deductibles.

Patients will share more of the load out-of-pocket, delaying payment to the ambulance industry nationwide.

Medicare Prior Authorization Demonstration Project

CMS’s goody bag of toys was loaded this year as they dropped yet another surprise down our chimneys with the advent of the Prior Authorization Demonstration Project in Pennsylvania, New Jersey and South Carolina.

All scheduled, repetitive transports billed to Medicare must now be prior authorized by the Medicare Administrative Contractor (MAC) in order to be paid.

We believe this to be a good thing in the long run simply because EMS agencies and patients, alike, will know that Medicare has made an up-front decision about the patient’s medical necessity. However, we’re skeptical about the implementation of this program and wince about the addition of another action layer required to comply.


And last but certainly not least, this is the year that we are told ICD-10 will become a reality. Mark your calendar for October 1, 2015. That’s the day we usher in a whole new level of documentation needs and coding challenges.

Remember the facts…

  • 13,000 diagnosis codes transition to 68,000 diagnosis codes
  • Codes will include mechanism of injury and contributing medical factors
  • Level of specificity required in the documentation to support the use of the codes will become even more important
    Will the industry finally be ready for this? Will insurance payers make the necessary adjustments to accommodate the new coding sets? Or come 10/1/2015 will we see a system that breaks under the weight of a new initiative that has been allowed to implement in piecemeal mis-steps?

Or…will once again Congress bend to the healthcare and insurance lobbies by delaying the implementation yet again?

I guess we’ll all find out next year!


Thanks for taking this ride with us. Please stay with us in 2015!
We’ll do our best to keep you informed and up-to-date. Until then, celebrate heartily but responsibly with family and friends and remember YOU made the difference between life and death in 2014 just like you have every year.

For those of you who will be on the job on those upcoming important days. Thank you! Please stay safe!

Merry Christmas and Happy New Year from all of us to all of you!

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