Ok, this gem appeared in my mailbox today.
I will have a couple of comments after jump as well, but the problem with this policy bulletin is that it does not take into account what routinely happens in cardiac arrest scenarios, especially in progressive EMS systems. Specifically, what happens when an ALS provider arrives on scene with a patient in cardiac arrest and the resuscitation is not successful in the field? Well, I was an EMS Supervisor for the Houston Fire Department for almost 6 years before I retired and a Paramedic my entire career. For the ENTIRE time I was a supervisor, we would work many cardiac arrest calls and NOT transport if the resuscitation was not successful in the field. This is a generally accepted practice.
But reading this Bulletin, it appears that Novartis only believes that this should be paid at the provider’s BLS rate! I know that CMS defines the ambulance benefit as a “transport” benefit, but this is monumentally foolish with regards to a modern EMS system. And they don’t even address this issue in the bulletin as neither example provided reflects the reality of a significant number of the cases actually occurring in the field.
The FULL text of the Bulletin after the jump:
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Holy ****. That is about all I can say about the opinion handed down by the Texas Supreme Court on Friday in City of Round Rock v. Rodriguez. If you valued your union representation at investigative interviews, you can likely kiss it goodbye for the time being.
In a split decision, with Chief Justice Jefferson and ...
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A Mission, Texas Firefighter has been terminated for the second time in a little over 2 years, according to a report posted on Curt Varone's Fire Law blog.
The firefighter was fired back in 2010 for a cover-up involving a backing accident that also led to the dismissal of two other firefighters. The current event involved ...
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From my inbox:
Sequestration Q&A
https://www.novitas-solutions.com/parta/info-alerts.html
https://www.novitas-solutions.com/bulletins/all/news-03112013.html
ISSUED: (03/18/2013 @ 3:00 PM)
Question: Does the 2% payment reduction under sequestration apply to the payment rates reflected in Medicare fee-for-service fee schedules or does it only apply to the final payment amounts?
Answer: Payment adjustments required under sequestration are applied to all claims after determining the Medicare payment including application ...
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CMS hosts Open Door Forums on several different topics on a regular basis. For those interested in the EMS business, the Ambulance Open Door Forum can be a valuable source of information, especially related to CMS priorities and thinking on reimbursement issues. The next CMS Ambulance Open Door Forum scheduled for:
Date: Tuesday, March 19, 2013
Start ...
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From my inbox:
Freshen Up This Friday on Ambulance Services
January 18, 2013 1:00pm-2:00pm Central Time (CT)
Ambulance Services
Webinar
1.0 CEU
Ambulance Service Providers, be sure to make time this Friday for a very informative webinar!
Are you looking to enhance your knowledge on proper billing for your services? If so, attend our event as we review findings from the analysis ...
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In a new Medicare Learning Network article, the Center for Medicare & Medicaid Services has announced that the Ambulance Inflation Factor (AIF) for2013 will be 0.8%. The AIF is designed to provide a basis for CMS Medicare Administrative Contractors (MAC) and Fiscal Intermediaries (FI) to adjust payment limits.
The Affordable ...
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A Houston area ambulance service operator plead guilty yesterday to conspiracy to commit healthcare fraud related to over $1.7M in billings for transports connected to "community mental health centers" If you don't remember, this case sounds very similar to some cases that I have previously
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The United States Department of Justice today unveiled charges against a total of 91 individuals in 7 different locations for allegedly fraudulent activities that allegedly cost Federal healthcare programs in excess of 535 million dollars. The highlights for EMS providers and Texas:
Alpha Ambulance Inc. (Los Angeles, CA): Approximately $49.2 million in fraudulent billing ...
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The Office of the Inspector General for the Department of Health and Human Services issued the FY 2013 Work Plan today. The Work Plan only has one specific reference to Ambulance Services; basically it is a repeat of last year's offering:
Ambulances—Compliance With Medical Necessity and Level-of-Transport Requirements
We will examine Medicare claims ...
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