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April 2015

NEWSLETTER

Latest Update to 2015 Fee Schedule
There are several separate laws that impact the Medicare ambulance fee schedule. The ambulance bonuses are one part of that equation, and those bonuses recently expired at the end of March. After their Easter break, Congress went back to Washington and passed legislation extending the bonuses through December 2017. This is good news for ambulance providers! The bonuses are 2% for urban transports, 3% for rural transports and 22.6% for super-rural.

These bonuses are retroactive to April 1, 2015. Since there will be a small number of claims that processed without the bonus payments, Medicare will be working to identify those claims and will reprocess them at the correct rate.

The zip code at the point of pickup is used to determine whether a transport falls into the urban, rural or super-rural category. This year, census data was used to adjust the designation of over 2,000 zip codes nationally. Some zip codes changed from urban to rural and some changed from rural to urban. No super-rural zip codes were changed. To see a list of the zip codes that changed in the Pacific Northwest, click here.

Another key part of the ambulance fee schedule is the Ambulance Inflation Factor (AIF). The AIF is calculated using the annual Consumer Price Index plus a productivity factor. Congress announced the AIF for 2015 in November 2014, which increased Medicare payments by 1.5%.

The last item affecting your Medicare reimbursement is the sequestration. This 2% decrease has been applied to Medicare claims since April 1, 2013 and is not scheduled to expire until March 31, 2016.

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More Payers Require Electronic Deposit

Among the many changes happening in healthcare, we are now seeing insurance companies move away from paper checks. This will be an on-going trend as ACH and electronic payments are becoming the industry standard. Medicare has required electronic payments for several years, and more payers are following suit (including Regence, Aetna and Group Health). Your response to our requests for signatures and bank letters has been outstanding. Our thanks and appreciation goes out to you and your staff! If you receive email notifications from any insurance companies or payers regarding enrollment for these electronic transactions, please forward them to our office.

We recently began providing an ACH report detailing these electronic deposits. We hope this report is helpful for you to track your electronic payments. Our month-end reports also list the electronic deposits by date. Unfortunately, electronic payers will occasionally deposit funds into your account without sending an explanation of benefits to the billing office. If your bank account shows any payments that we have not reported to you, please contact our office so that the patient accounts for which payment was received can be properly updated.

Legally Speaking: Medicare Patients and Collection Surcharges

Every provider who enrolls in Medicare must agree to only collect the patient's copay and deductible. Our Medicare contractor, Noridian, recently issued a memo further describing specific items and explaining whether or not those items can be billed to patients. Items that you can bill to Medicare patients include the cost of copying records and the cost of returned checks. Items that you cannot add to a Medicare patient's bill are finance fees and collection fees.

If your collection agency covers the cost of collections through a surcharge, we have contacted them to establish a separate policy for Medicare patients. We appreciate everyone's willingness to help implement these required changes.

FSA/HSA Accounts and Your Levy Program

Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) are financial accounts set up through a patient's employer. A portion of the patient's pre-tax salary is deposited in their account and is used to pay qualified medical expenses. The FSA accounts are entirely funded by the employee. The HSA accounts can be funded by both the employer and employee. All deposits into these accounts are the property of the employee, with the requirement that monies are to be used for medical expenses only.

Patients are allowed to pay their ambulance bill using funds from their FSA or HSA accounts, and we are receiving a growing number of these payments. If your agency waives out-of-pocket expenses under a resident waiver program, we do not accept payments from FSA/ HSA accounts for any resident balances since they are considered out-of-pocket funds.

Washington State GEMT Program

As you may be aware via the Washington Fire Chiefs, there is legislation (HB2007 and SB5840) that is currently being passed through the Washington State House and Senate that is expected to be ratified by the Governor in June of this year. This legislation is significant to all Public Fire Service organizations as it will allow access to Federal Medicaid Program Funds that are currently available.

Systems Design is monitoring this program and preparing to assist our 98 Washington State Public Fire Service clients in acquiring all reimbursement that they are entitled to from these funds. Once this Washington State program is implemented, reimbursement will be retroactive back to the date the Governor signs the bill. This program offers to reimburse these organizations up to 50% of the Washington State Medicaid fee schedule write off amounts, depending upon their respective cost analysis. For more information about this program, click here.

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Payer Mix Changes

Most aspects of the Affordable Care Act were implemented in January 2014, and we have since been noticing some changes and new trends in our clients' payer mix. We are seeing an overall increase in Medicaid transports, as well as an increase in Medicaid fee schedule write-offs as a result. We are also noticing an increase in Medicare, a decrease in commercial insurance, and a decrease in private pay accounts. Some of our clients have realized only a slight decrease in overall revenue.

Once the Washington State GEMT reimbursement program is up and running, we expect to recover up to 50% of the State Medicaid fee schedule write off amounts through this program. Due to the increase in Medicaid transports mentioned above, this additional revenue should help to counteract any revenue declines. This GEMT program is expected to have a very positive impact for public EMS agencies.

We welcome suggestions of topics of interest for future newsletters. Please contact our Executive Adminstration Assistant, Elen Sia, at 360.394.7028 or send her an email at ElenS@SDWems.com.

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Reference Documents

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