Category Archives: Medicare

Novartis Posts Q&A on Effect of Sequestration on Medicare Payments

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 Ambulance Open Door Forum tomorrow, March 19th, 2013

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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New HHS OIG Work Plan – Same Old Stuff for Ambulance Services

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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I’ve Received a Subpoena from the Feds . . . Now What? Part 2

Obviously today is not Thursday . . . but I am back today with the follow-up post. In Part 1, I discussed the initial steps if you get a subpoena from a government agency.  Today, what are your obligations if you received a subpoena? First, let your attorney (OK, if you did not get that ...

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I’ve Received a Subpoena from the Feds . . . Now What?

Based on the recent activities of the HEAT strike teams in Texas (see here, here and here) , I would anticipate that many ambulance and other small healthcare providers may be getting subpoenas in the near future.  What should you do if you receive a subpoena from any government agency? This should ...

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CMS temporarily holding payments after January 1

The Center for Medicare Services (CMS) sent out an email to the Ambulance listserve yesterday stating that they were instructing the Medicare Administrative Contractors (MAC) to hold payments pending an update to provisions of the Social Security Act that have increased payments for ambulance services.  The current law expires December 31st and the update was ...

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Houston Doctors Indicted in Medicare Fraud Sceme – Can the Ambulance Services Be Far Behind

On Wednesday, two physicians and the owner of an assisted living facility in Houston were arrested on charges involving Medicare Fraud.  These arrests are related to the recent series of articles in the Houston Chronicle documenting large volumes of Medicare payments going to Ambulance services who transport mental health patients from assisted living facilities and ...

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City of Dallas Pays Nearly $2.5 Million to Settle Medicare/Medicaid Fraud Claim

Following the jump is a press release from the United States Department of Health and Human Services and Department of Justice regarding claims of upcoding by the Dallas Fire Department for Medicare and Medicaid claims.  I highlight this to note that it is not only the non-emergency ambulance services transporting dialysis patients that are paying ...

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Trailblazer Posts Notice Regarding Ambulance Dialysis Transport

Today, Trailblazer issued a notice the the ambulance supplier community regarding transports to and from dialysis.  Basically, Trailblazer is stating that based on alleged over utilization of ambulance transportation services for a residence to dialysis center transport (RJ and JR modifiers), they will pay the first 12 claims of the year without documentation.  After that, ...

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Medicare Audits Biting Houston Area Ambulance Companies Where It Hurts – In the Bottom Line

I have previously posted about the travails of one Houston ambulance service owner who had taken his complaints about the treatment of dialysis patients to the media.  Apparently, the initial reports were only the beginning - I don't watch the local Fox station, so I missed the follow up of the ...

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