Medicare Changes Proposed

Last Week

Big news hit the ambulance industry’s electronic inboxes last week, when the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2020 Proposed Rule with revisions to Payment Policies under the Physician Fee Schedule including Other Changes to Part B Payment Policies. Two ambulance industry changes were embedded in the proposed rule- a change to Physician Certification Statement expectations and the establishment of a brand new Ambulance Data Collection System.

Medicare Changes ProposedCMS will entertain comments on the proposed rule now through September 27th, the rule will be published in the Federal Register in November with all changes becoming effective January 1, 2020.

The proposed rule calls two actions for the ambulance industry. In this blog post we will focus on the changes to the Physician Certification Statement (PCS) requirement.

Our next blog, and subsequent additions to this space, in the near future will detail the addition and first-time establishment of an Ambulance Data Collection System as mandated by Congress following the multi-year extension of the Medicare add-on payments last year.

Alter instead of Replace

President Trump campaigned on eliminating unnecessary, obsolete or excessively burdensome regulations. So, it comes as no surprise that CMS pushed for PCS changes noting that the intention was to add clarity for ambulance suppliers and providers.

The proposed rule explains that CMS listened to and are responding to comments from the ambulance industry stakeholders in proposing these changes. They further explained that the recommendation to alter the “…structure of the existing regulatory framework” was considered, in the end, preferable to scrapping existing rules and replace with brand new PCS rules. With this new rule, CMS goals are to provide the ambulance industry with a bit of flexibility while directing the focus of the PCS away from the form and place the emphasis on the intent which has always been backing up with written proof that other transport options are contraindicated while establishing patient medical necessity for the transport

Two Definitions

CMS is now defining two sets or types of certification statements.

The first is the Physician Certification Statement. The second is the non-physician statement.

CMS used the proposed rule to remind the industry that they never mandated any single form to act as the PCS. CMS used language in the proposed rule to boldly state that the intent of the PCG rules was never to seek an “order” from a physician for transport. The CMS rules seek supporting documentation from a person with direct knowledge of the patient’s condition other than ambulance personnel which will verify the patient’s need for ambulance transport such that Medicare should pay for the transport.

Who Can Sign Now?

This rule allows the ambulance service may use an actual developed form or it may rely on other supporting documentation.  Persons other than a physician – the “non-physician” can sign documentation as long as the person signing is a facility staff member that has both personal knowledge of the patient’s condition at the time of the transport and meets the employment requirements as a staff member of the facility. CMS is proposing to expand the list of staff members that can sign-off on this non-physician documentation – a specific form or other documents such as EMTALA forms, medical transport forms and the like. Current signatories other than physicians include physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNSs), registered nurse (RNs) and discharge planners.

Expanding the Approved Signatory List

The proposed rule expands this signatory list to now include licensed practical nurses (LPNs), social workers and case managers to the list of acceptable signatories approved by CMS.

All of the above persons can sign the statements to be handed off when ambulance providers and suppliers are unable to obtain a signed PCS from the attending physician. The attending physician remains that most desirable signatory.

CMS emphasized that these other non-physician staff members must be employed by the beneficiary’s attending physician or the hospital or facility where the beneficiary is being treated and transported from and have personal knowledge of the patient’s condition at the time the ambulance transport is ordered.

This is a welcomed addition and will help spell relief for the ambulance industry which, at times, has struggled to obtain PCS forms with acceptable signatures.

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