Compliance

Medicare Advantage Primer: What You Need to Know
By Barbara Davenport
In Medicare reimbursement for ambulance services, one size does not fit all. For non-emergency transports, knowing whether a patient’s coverage is traditional Medicare or Medicare Advantage can mean the difference between getting paid and eating the cost.

Hospital Invests in EMS CPAP and Saves Money
EMS agencies are reimbursed for medical transportation based on the patient’s condition at pick-up and the medically necessary level of service provided to the patient before and during the ride to the hospital. Once at the hospital, patients are assigned a code called a DRG (for Diagnosis Related Group) based on their medical diagnosis. The DRG imposes limitations on the reimbursement that the hospital can receive for that patient’s care. Services considered unrelated to the DRG are not covered under Medicare and Medicaid.

How Hospital Reimbursement Rules Brought ALS to Rural Nebraska
By Karen Edwards
Before CAH designation, the ambulance service run by the 20-bed Nemaha County Hospital in Auburn, Nebraska, was typical of many rural EMS operations: It relied on volunteer EMTs to staff its ambulances. With only 120 to 140 transports a year, its EMTs struggled to maintain their skills. Tougher education requirements demanded more time to maintain certification; yet, even if volunteers could find more time, employers were increasingly unhappy about paying employees who were gone from their jobs for hours or even an entire day transporting patients close to 140 miles round-trip to hospitals in Omaha and Lincoln.

Fire Departments Lacking in EMS Data Collection
A field test of EMS system performance measures developed by the International Association of Fire Fighters (IAFF) has found that most fire departments do a terrible job of collecting EMS system data for use in generating meaningful performance reports. The problem is so bad, said IAFF Director Lori Moore, DrPH, MPH, EMT-P, that the IAFF’s EMS Performance Measurement software, to be released next year, will now include data collection as well as report-generating functions.

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