2018 Ambulance Payment Data Released

AAA Capsule

Thanks to the American Ambulance Association’s efforts to keep all of us in the ambulance industry informed the Association has compiled and released the ambulance 2018 Medicare Payment Data Report to all AAA members.

2018 Ambulance Payment Data Released

The report was compiled and posted using payment data derived from the “Early Edition” of the 2018 Part B National Summary Data File (previously known as the BESS file) as released by CMS each year (full report available at CMS.gov/Research-Statistic).

The AAA provided statistics for the number of services allowed and the amount of payments made by Medicare to Part B suppliers. As a handy point of reference, the Association also provided side-by-side comparison numbers broken out by level of service/HCPCS codes and a comparison versus the same numbers as reported for 2017.

All Totaled…

The total of all Medicare Part B ambulance payments amounted to $4,833,825,129.02 for 2018. All Medicare benefits totaled $731 billion which is 15 percent of total federal spending in the United States in 2018.

As you can see, Part B ambulance payments (the lion’s share of ambulance payments originate as Part B payments) account for just 0.66 percent of total Medicare spending. Yet the laser focus on our industry has been noticeably disproportionate to the share of spending that is represented by ambulance payments.

Comparing Year to Year

Overall, Medicare Part B ambulance payments decreased by 1.15 percent even while the number of approved line items increased by 6.44 percent.

It’s notable that spending on Fixed Wing air ambulance transport increased by 3.43 percent, or just over $2 million and in tandem spending on Fixed Wing mileage payments was up by 11.45 percent compared to 2017 for an additional $5 million paid out in Fixed Wing air ambulance transport claims.

In the ground ambulance category, ALS Emergency transports accounted for the most dollars paid on claims, totaling $1.6 billion in 2018. This total, however, represented a slight decrease of 1.34 percent, accounting for a decrease in payments overall for this level of service by $22.5 million.

As the target of many audit and even fraud and abuse reviews, payments made for the BLS Non-Emergency level of service fell overall by 4.11 percent when compared to 2017. This trending has continued for a few years as CMS and Congress has mounted its “attack” on all-things non-emergency ambulance, especially at the BLS level which correlates with the laser-focus reviews of dialysis-related transports represented by the Medicare pre-authorization demonstration program, which is expected to soon expand nationwide.

Dialysis takes another hit…

As efforts continue to combat government-perceived overpayments for transportation provided to dialysis or End Stage Renal Disease (ESRD) beneficiaries, spending for these transports lessened by 6.75% over 2017 with 1.14% fewer line items approved for Medicare payment on these trips.

In all, spending decreased for dialysis-related transports by just over $32 million, falling from $477.6 million in 2017 to $445.4 million in 2018.

Puerto Rico Sees Increase

The AAA report conveniently breaks out the payment results by State and U.S. Territory for a deeper review.

U.S. territory, Puerto Rico, saw the sharpest increase in Medicare Part B payments for ambulance transports of any territory or state in the United States, as reported payments rose by a sizeable 21.92 percent, with payments for dialysis-related transports increasing by a whopping 40.27%.

However, in total dollars paid, the increase in Puerto Rico represented just a $2 million increase in actual ambulance spending for Medicare.

The State of Wyoming also saw an increase of 10.59 percent, which equates to just $900,000 additional monies paid. Other states seeing an increase in ambulance payments from Medicare included Alaska (+8.56%) and Montana (+8.15%).

In contrast, ambulance payments in Connecticut decreased by the widest margin, falling by 7.58 percent in 2018. Connecticut’s decrease totaled $6.1 million fewer ambulance transport dollars flowing to the Constitution State.

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