Musings of a Public Health Emergency- So Far
By Chuck Humphrey, B.A., EMT-B, CAC, CADS*
Rear-View Mirror
Like me, I’m sure that you have taken some time to reflect on what you have learned over the last 15 months since COVID-19 crashed its way into all of our lives.
Those of us who serve in whatever capacity in EMS, certainly have been affected in an enormous way. As an ambulance billing partner, it occurs to me that I may be able to unveil what I’ve seen cross our desks in this unique time in history.
Let’s look in the rear-view mirror in just a few words.
The Matrix
The best way that I believe I can adequately describe the last year’s events is to point to all of this pandemic’s happenings in parallel to the movie The Matrix, with its “bullet time” visual effects of real time and slow-motion ebbs and flows.
We used the word fluid continually in this office because at one moment we were speeding toward educating our clients about waivers and stimulus incentives and uninsured patient payment programs only to learn two minutes later that there was something new to focus on.
Unlike no other time that I can remember in my career in EMS and EMS billing has there been so many unique government-driven changes and revisions. I hope you were able to stay on top of them, because there is coming a day soon when the auditors will begin knocking on doors.
Stay tuned!
Speaking of Audits
And, on that note, speaking of audits…THEY’RE BACK!!
What a unique time was 2020 when the typical CMS and state-driven Medicaid audits came to a grinding halt. Certainly, we all found the relief quite refreshing. But, by the same token, I can’t help but wonder if it didn’t put some of us in a false sense of security.
Probably the most unsettling part of it all is reading news articles detailing some immediate fraud incidences of healthcare providers who attempted to or achieved fraud by bilking the system while taking advantage of some of the relaxations meant to support the healthcare industry as a whole.
And, of course, we all know that because of these- dare I say, knuckleheads, we’ll all pay dearly as we now see the ratchet-up of auditing unleashed over the past month or two.
If you think you got away with something, chances are you are at risk for an orange jumpsuit to be added to your wardrobe very soon! So, get ready…the boom is hitting as we all expected.
From Ambulance Driver to Health Care Provider Overnight
If just 18 months ago you’d have told me that in a blink of an eye, EMS would be seen as a healthcare provider and less of an ambulance driver, I’d have laughed.
But this COVID-19 pandemic immediately thrust EMS agencies and their staff into the role of healthcare provider and without a period of elongated testing and examination. Now, don’t get me wrong, we haven’t completely arrived just yet.
Yet, in the last month alone, we have seen CMS issue a waiver allowing for reimbursement of a base rate less mileage for treatment in place. Most of us didn’t anticipate anything even remotely close to such an exception without, at least, an extensive review of the infant ET3 demonstration program.
But here we are.
Medicare, although limited in scope and practice for the time being, is allowing for a shift in a paradigm that has existed since everyone awoke to the fact that Medicare pays for ambulance transports. This alone is probably one of the largest gains for the EMS industry in the United States. The ripple effect from this one brief off-ramp will set the ground for a shift in the payment model and the entire landscape for EMS, be it operations, billing and reimbursement or even recognition as an accepted individualized player in the larger healthcare screening.
I have no doubt in my mind that Congress, CMS, state governments and even insurance payers will soon (tomorrow, probably not, but soon) be announcing new avenues to reimburse EMS agencies for medical services provided in the field and without requiring that we transport our patient be paid.
If that is the silver lining in this COVID-19 painted cloud, somehow, we will all be able to look back and point to where our industry took its next big revenue model leap.
*Chuck Humphrey is the Senior Director of Compliance and a Territory Sales Manager for Quick Med Claims. He is one of our industry experts with over 30 years of experience in the EMS industry.
