The Centers for Medicare and Medicaid Services (CMS) published a Final Rule that drastically enhances the government's ability to crack down on fraud and abuse in federal healthcare programs. For the ambulance industry, this means increased compliance obligations and more scrutiny from federal and state investigators.

What are the enforcers targeting?

Upcoding, billing for services not rendered at all, improper signature practices and deficient and falsified PCS forms for non-emergency runs.

What Should you do?

Train your staff on proper signature practices, billing procedures, good field collections and ask us for help. 

Over the past 21 years, Medicount Management has been the primary source for our clients for maintaining compliance with the changing rules and regulations.  We have documentation training presentations available just like the ones we performed at our last user conferences.   We also can provide you with sample signature letters for your crew to use just like the ones we provided at our last user conferences. 

Does is sound like those user conferences are beneficial?  You bet!  Stay tuned for our 2011 series later this year.   

You mean we are actually getting a bonus?

On January 1, 2010, Medicare and Medicaid services restored the 2% urban, 3% rural, and 22.6% super rural bonus payments for ambulance claims beginning on January 1, 2010.  Since  Medicare contractors already processed those claims at the lower rates we had to wait until reprocessing of those claims occurred to get the extra money due.   Well, it looks like that time has finally come.  

The Centers for Medicare and Medicaid Services (CMS) just announced that it will begin to process the retroactive bonus payments that were implemented last march affected claims from the first half of 2010 over the next several weeks.   

So what do you need to do?  Nothing. CMS states that in most cases your Medicare claims administration contractor will automatically reprocess your claims at the higher rate.  We will all be looking forward to that.