CMS issued a Proposed Rule that would limit ambulance providers' ability to "backbill" Medicare for certain services and enhance some the other "fraud-fighting" Medicare regulations. It's not too late to register for an abc3 conference this spring, where we'll tackle the proposed changes and discuss how CMS is taking a cue from the IRS by increasing fraud reporting incentives.

On July 30, 2012, CMS published a Proposed Rule that would make clear that a PCS for scheduled, repetitive non-emergency ambulance services carries no conclusive weight in determining medical necessity. The Rule also makes several technical regulatory changes regarding ambulance reimbursement. PWW is asking everyone in the EMS industry to comment on the Proposed Rule because it could have a significant negative impact on the industry.

The OIG recently issued another report: Medicare Payments for Part B Claims with G Modifiers, assessing how Medicare contractors are processing G modifiers and found that there are “vulnerabilities in how Medicare pays for these claims.” These “vulnerabilities” are resulting in improper payments of claims submitted with G modifiers. The report underscores the importance of using appropriate denial modifiers and tracking claims with G modifiers to make sure that Medicare is not improperly paying your agency for a service that should have been denied.

On May 8, 2013, the Office of the Inspector (OIG) issued an updated “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs.” Ambulance providers are going to have to significantly ramp up their screening efforts by running monthly OIG screening checks and including providers who “order” non-emergency transportation services in their screenings.

Novitas, the Medicare Administrative Contractor (“MAC”) for Jurisdiction 12 (covering Pennsylvania, Maryland, New Jersey, Delaware and Washington DC), released a new “Local Coverage Determination” (“LCD”). This “LCD” went into effect on April 12, 2012.