OIG Report – Overpayments For Non-Emergency Ambulance Transports To Non-Covered Destinations The Office of the Inspector General released its report “Medicare Improperly Paid Providers for Non Emergency Ambulance Transports to […]

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On September 14, 2017, CMS held its latest Open Door Forum. As usual, it started with a few announcements, as follows: “Locality” Rule – On 6/16/17 CMS issued Transmittal 236, […]

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Maxmed is a home health agency. In 2011, Medicare reviewed a sample of 40 claims involving 22 Medicare beneficiaries and determined that all but one were not medically necessary. The sample […]

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“Locality” Rule – MAC Discretion – Since the inception of the CMS Internet Only Manual (in 2003), the Benefit Policy Manual 100-02, Chapter 10, section 10.3.5 has always defined “Locality” […]

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CMS has issued an MLN Ambulance Transports Booklet. The booklet (36 pages) can be downloaded here. One section of the Booklet that you might want to keep handy involves Free-Standing Emergency Departments. Specifically, […]

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Office of the Inspector General – Final Rule – Revisions to the Safe Harbors for Waiving Coinsurance, et.al On December 7, 2016, the Office of the Inspector General published a […]

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The Centers for Medicare and Medicare Services (CMS) issued Transmittal 3625 officially announcing that the inflation factor for payments under the Medicare ambulance fee schedule for 2017 will be 0.7%. […]

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Prior Authorization – Repetitive Non-Emergencies – Expansion Delay CMS has notified the American Ambulance Association that the expansion of Prior Authorization for repetitive non-emergencies, to the states not already on […]

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This advisory is for members who have Novitas as their Medicare Administrative Contractor. On August 17, 2016, Novitas called me to let me know that they are seeing many ambulance […]

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CMS released preliminary data on the impact of the prior authorization demonstration program on Medicare payments for ambulance services.  This data is limited to the three states (NJ, PA, and […]

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By David M. Werfel, Esq | AAA Medicare Consultant Updated February 16, 2016 Federal law requires that state Medicaid programs cover necessary transportation to and from health care providers in […]

The post Medicaid Waivers to End Coverage of Non-Emergency Transportation appeared first on American Ambulance Association.

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By David M. Werfel, Esq. | Updated November 6, 2015 On November 5, 2015, the Centers for Medicare and Medicaid Services (CMS) conducted its latest Ambulance Open Door Forum.  As […]

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CMS published MLN Matters article number SE1521, which states: “For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed MACs and QICs to limit […]

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CMS held its latest Ambulance Open Door Forum on April 22. It started with the following two announcements: – H.R. 2 was signed into law extending the temporary ambulance adjustments […]

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Based on implementation issues involving the Prior Authorization program for repetitive patients inSouth Carolina, Brian and I had a conference call with representatives of CMS and Palmetto on Friday January […]

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