HHS OIG Issues Advisory Opinion Regarding ALS Billing by BLS Ambulance Companies

The Department of Health and Human Services Office of the Inspector General issues an new advisory opinion today, No. 12-12, which addresses the billing of ALS services by a BLS level ambulance service.  The opinion, signed by Greg Demske (full disclosure: I know Greg personally from the ABA Health Law Section leadership council), walks you through how the contract is set up – basically, a BLS ambulance supplier uses an ALS service for ALS intercept purposes. Until now, the BLS billed the BLS rates and the ALS supplier billed the patient directly because they could not bill Medicare directly (the no transport-no payment rule).

Under the proposed arrangement, the BLS ambulance service would bill Medicare for ALS services, when they are provided by the ALS provider, and would then pay the ALS service the difference between the BLS and ALS reimbursement. While this might increase the total cost to Medicare, because the ALS rate is higher, there is not an issue with a violation of the Anti-Kickback Statute.  The reason is how the flow of the payments worked under this contract – the BLS company paid the ALS provider, with no payments going from the ALS provider back to the BLS provider. Under this arrangement, there is no kickback and no violation.  However, the caveat, as with all OIG opinions, is that this opinion is only valid as to the arrangement they analyzed and your experience may be different.

Link to the OIG opinion.

Marc

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