ALERT – It’s Time to Extend the Medicare Extenders!!!

By Chuck Humphrey, B.A., EMT-B, CAC, CACO, CADS, *


Difficult Times

It comes as no secret to any of us in the EMS world that we are in difficult financial times. Fuel prices are sparking a double whammy on top of inflation to create the perfect storm for our industry. An industry that is already experiencing the most challenging times.

Now, add to that the possibility of losing Medicare dollars by way of the expiration of what we call the Medicare extenders, and the outlook can become even bleaker if our decision-makers in Washington act.

Toy Ambulance sitting on several hundred dollar bills with a stethoscope and question mark next to it


Band-Aid Fix

I won’t assume that everyone reading this blog post is aware, so allow me to remind you of what’s at stake here.

Two decades ago, when the CMS National Medicare Ambulance Fee Schedule was incepted, it didn’t take long for all of us to realize that the formula to determine ambulance reimbursement by Medicare was totally flawed. The industry sounded the alarm, loud and clear, and the Fed’s way of fixing it…well…was the way it seems our Federal Government fixes everything in this modern era. They put a “band-aid” on it to stop the financial bleeding, by adding Medicare Extender payments.

Ambulance providers and suppliers transporting from zip codes considered urban in nature receive a 2% increase. Transporting from zip codes considered rural in nature receive a 3% boost and super rural zip code-originated transports are paid with an additional 22.6% added in. Rural and super rural transports also receive a 50% payment bump on the first 17 loaded mileage reimbursement above the amount prescribed in the Medicare fee schedule.

These Extenders were literally renewed each year for many years riding on what was called the “Doc Fix”, tied to another stop-gap for physicians. The physicians finally lobbied successfully to obtain a permanent fix, leaving the ambulance Extenders hanging out to dry. So, Congress agreed to apply a band-aid to the band-aid and extended the Extenders for a few more years with the intent of reviewing ambulance costs by way of the Ground Ambulance Cost Data Collection initiative that is happening as we speak.

Of course, the COVID Public Health Emergency delayed the whole process of coming up with a permanent fix based on the examination of ambulance costs. That means Congress will not have time to review ambulance cost data in order to make an informed decision about how to fix the inequities in Medicare payments once and for all.  

And thus, we land on the need to beg our government for another extension of the Extenders.


If They Do Nothing…

If Congress does nothing, the Extender payments will expire as we are all celebrating the coming of 2023 and the ambulance industry will take yet another hit.

Will this happen?  Probably not…at least I certainly hope not…but, then again, none of us thought that we’d lose 2% of our Medicare dollars to sequestration and that did happen for lack of action when we all assumed it wouldn’t!!

And so, here we are lobbying for passage of yet another set of companion stop-gap bills (H.R. 2454 and S. 2037) as we arrive in the final quarter of 2022. The American Ambulance Association, to their credit, is also asking all of us to lobby for an increase on the extenders, seeking a bump to 3.4% for urban, 4.3% for rural and 26.7% for super rural to account for the negative effects of inflation and skyrocketing fuel prices.


My Two Cents…FIX IT NOW!!!

After spending 36 years as an EMS provider with the last 25 years helping EMS organizations achieve their reimbursement goals, I’m going to add my two cents here (and note- by two cents I’m being tongue-in-cheek deliberate because it seems like that’s what our decision-makers throw at us- PENNIES!!) 

But, I digress… I say…FIX IT!!!  NOW!!! Why do we continually have to beg just to make ends meet?

If I sound frustrated…frankly…I am!

For the love of all that’s holy. Do we have to debate about how important keeping our American EMS system alive is after we watched the horrors of what COVID has brought to our lives? Do we have to witness one-more mass casualty incident to not wake-up to the stark reality that if we fail to properly fund our EMS system it will crash right when it seems we need it the most?

I implore you all, write, call, and visit to urge the members of the United States House of Representatives and members of the Senate to pass legislation TODAY to, at the very least, extend the current Extenders. Or…why not ask them to throw us all a bone and increase the Extenders?


And…for the love of Pete…don’t wait until 11:59 p.m. on December 31st to do it! Oh, and don’t kick the can down the road until early 2023 and then retroact all the payments which creates an accounting nightmare!  

Do it now!!!!

Literally, lives depend on it. What’s it going to take for the talking heads in Washington to wake-up to the fact that we are losing EMS provider and supplier organizations by the thousands on top of losing individual first-responder providers to the point that we can’t fill trucks to do the job at hand?

I hope nothing drastic.

Here’s the cry.

Act now!


*Chuck Humphrey is an independent contractor who spent 25 years in the EMS revenue cycle management industry, prior to his retirement from Quick Med Claims. In addition to holding active EMT credentials in Pennsylvania, he is also a Certified Ambulance Coder, Certified Ambulance Compliance Officer, and Certified Ambulance Documentation Specialist via the National Academy of Ambulance Compliance. Humphrey is a periodic guest contributor to the QMC blog and podcast space.


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