CMS has issued a proposed rule designed to improve the accuracy of payments under the ambulance fee schedule and incorporate changes in geographic adjustments based on the most recent census data. The proposed rule would resolve several issues that have arisen since April 1, 2002, when CMS began phasing in the ambulance fee schedule. One change would revise the designation of areas as urban or rural to incorporate changes made by the Office of Management and Budget to reflect the 2000 census data. The proposed rule would lead to some redistribution of aggregate Medicare payments among ambulance services, since trips originating in a rural area are generally paid at a higher rate than urban trips. But in newly designated urban areas, an ambulance company would be expected to have a greater volume of business.
The proposed rule would also clarify that the extra payment for specialty care transport applies only to hospital-to-hospital ambulance transportation. In addition, the rule states that the extra payment for emergency responses is available not only to ambulances responding immediately to a 911 call, but also to ambulances available in a hospital setting when a 911 call is unnecessary to respond to an emergency. CMS is also proposing to discontinue formal annual reviews of “low billers” and air ambulances to determine whether adjustments are needed in the ambulance fee schedule conversion factor.
