Medicare Add-On Payments- Time is Running Out!

Five Months!

Five Months have passed since Senators Stabenow, Roberts, Leahy, Collins and Schumer introduced S. 967 entitled the “Medicare Ambulance Access, Fraud Prevention and Reform Act of 2017” and yet the legislation has not passed. Companion bill H.R. 3236 also remains in limbo.

What’s worse- the ambulance industry remains in limbo.

Medicare Add-On Payments- Time is Running Out!

We’re just three months away from what potentially can be a serious blow to the ambulance industry should the add-on bonus payments be allowed to expire. Already underfunded, our industry will lose even more precious dollars that we can’t afford to forfeit.

Time for Action…

Now is the time for you to take action.

The American Ambulance Association is promoting an easy way for you to contact your Federal legislator with an urgent request that he/she take action on the measure today. A quick visit to will provide you with an easy method to send your Congressman or Senator a message. There’s no time to waste.

And with that in mind, earlier this year we blogged a 4-part series about the importance of these bills to the ambulance industry in America. To re-educate you on the matter, we are including highlights from Part I of the series from May to remind all of us of the urgent need to push this legislation to passage.

We hope you take time to read, understand and act!

4 Parts

S. 967 (and H.R. 3236) addresses four areas to benefit all of EMS in America.

  • Reform to the Medicare ambulance fee schedule
  • Prior Authorization for ambulance transports of ESRD beneficiaries
  • Requiring providers of services and ambulance service providers to submit cost data and other information with respect to ambulance services
  • Treatment of ambulance service providers

It’s important to remember, however, that as the American Ambulance Association (AAA) has warned, there will most likely be changes that take place as the bill gets passed around through the Finance Committee and then, hopefully, to the floor for final consideration.

Reform to the Medicare ambulance fee schedule

It’s been 15 years since the inception of the Medicare ambulance fee schedule.

However, it didn’t take long for all of us to realize that the fee schedule underfunded most of us. Lobbying efforts produced a “band-aid” measure called the add-on bonus payments. Each year for many years Congress has passed these add-on payments on top of the fee schedule payments- 2% additional for urban areas, 3% for rural and 22.6% for the most remote areas of the Country labeled as super-rural. Plus the rural and super-rural areas receive a 50% increase in the mileage payment above and beyond the fee schedule amounts.

These add-ons always rode the coattails of what was then-known as the “Doc Fix” for the physician fee schedule and always were passed in the 11th hour just before (and one year even after- then paid retroactively) they expired. Left to lapse and the American ambulance industry would have reeled to fill the gap in reimbursement.

But, the “Doc Fix” has been permanently fixed, which means at the end of this year unless this measure passes the add-ons will disappear and with no real avenue to extend them, as in the past.

Increase the conversation factor for ground ambulance services

S. 967 and H.R. 3236, if passed, will permanently increase the conversation factor in the Medicare ambulance fee schedule to include the add-ons in the fee schedule calculations.

The super rural is proposed to increase by 25.6%, the rural census tract areas would remain at 3% and urban approval rates would be boosted by the same 2% factor. The revisions would become effective January 1, 2018.

Mileage boosts would be calculated at an additional 3% for the super-rural and rural areas and the urban providers would actually see an increase of 2% within the calculation methodology.

Important Why?

The Why of this is simple.

No ambulance service that we know of can stand to lose a single penny. Losing 2%, 3% or 22.6% of our money potentially would drive the final nail into many an EMS system’s coffin of demise. Costs have skyrocketed while reimbursement have been stale- and that includes the bonus payments.

If left to languish, already squeezed EMS budgets would be choked.

Now’s the time to push hard. Take action! Contact your Leislator’s office TODAY to advocate for S.967 and H.R. 3236 to pass. Time’s running short- there’s no time to waste.

Act now!

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