Medicare Add-On Payment Brinksmanship – AGAIN!!
By Chuck Humphrey, B.A., EMT-B, CADS*
Tired of the Game!
Speaking entirely for myself, I’m really tired of the game of brinksmanship surrounding the Medicare add-on payments to the Medicare ambulance fee schedule.
I know I share the sentiments of the majority of the American ambulance industry when I write these words.
For nearly two decades, this revolving game just keeps on giving at Christmas time. Year after year, about this time of the year, Congress perpetually waits until the very last possible minute to approve countless extensions to the add-ons.
And thus, here we are again!
The deadline for the expiration of the latest round of add-ons looms with the approach of another New Year’s Eve and, as of this blog post, no decision has been made.
Some History
What are the add-ons and why are they so important?
The add-on payments to the Medicare ambulance fee schedule date back to 2007 following the inception of the Medicare ambulance fee schedule in 2002 (yes, I’m old enough to remember this!)
From the beginning of the fee schedule, the calculations were found to be flawed. This prompted the government’s General Account Office to study and report their findings to Congress. The study “Ambulance Providers: Costs and Expected Medicare Margins Vary Greatly” (GAO-07-383, 2007) reviewed the Medicare ambulance fee schedule’s impact on EMS in the U.S.A. dating back to 2004, ultimately determining the industry to be underfunded by approximately six percent. On the heels of the report and thanks to the industry’s group lobbying campaign, Congress voted to tack on additional payments of 2% for transports originating in urban zip codes, 3% for rural and 22.6% for transports originating in remote super rural areas.
Back then, the add-ons “piggybacked” on what was annually known as the “doc fix” which was the physicians’ own correction factor and passed annually without real fanfare. Permanent legislation which addressed the Sustainable Growth Rate (SGR) formula was finally repealed and replaced with a new payment system in 2015 when the Medicare Access and CHIP Reauthorization Act (MACRA) mothballed the SGR for good and placed the physician model into a pathway moving toward a value-based payment model.
The “docs” breathed a sigh of relief.
But this meant that the ambulance add-on payments suddenly had no mechanism for assured annual renewal and the proverbial can got kicked down the road again and again and again.
Current Proposed Legislation
Fast forward to today. The ambulance industry in America once again faces the loss of revenue if Congress fails to act soon.
Two pieces of legislation have been proposed on Capitol Hill.
House Bill H.R. 1666 (Wenstrup, Sewell, Carter and Tonko) calls for the extension of the 2%, 3% and 22.6% add-ons at their existing levels for an additional three years.
Senate Bill S.1673, also known as The Preserving Access to Ground Ambulance Medical Service Act of 2023 (Cortez Masto, Collins, Stabenow and Cassidy) not only proposes a new three-year lease on life for the add-ons, but it also proposes to increase payments to help offset rising EMS operations costs. The proposed increases are:
- Urban 3.4% (up from the current 2%)
- Rural 4.3% (up from the current 3%)
- Super rural 26.2% (up from the current 22.6%)
With the big NYE ball dropping in New York’s Times Square just a little over three weeks away as of this blog post, there is no time to waste. Without renewal of the add-on payments, already hurting EMS agencies will be forced to tighten the belt, cut services and in some cases, face shut down!
What can I do?
If that is the question you’re asking, there is a simple answer.
Call your federal legislator TODAY!
Additionally, the American Ambulance Association has provided a letter writing tool for you to use, making the contact with your representative (House or Senate) on Capitol Hill as easy as a few keystrokes.
It is vital we let Congress know that, in the very least, we are demanding the add-ons to be extended. Of course, it would be helpful if they passed S.1673 and provided much needed additional add-on funding.
But wouldn’t it really be a great Christmas gift in 2024, if Congress simply fixed the Medicare ambulance fee schedule once and for all. The financial well-being of American EMS is critical for today and the future!
Get it done!!
*Chuck Humphrey is an independent contractor who spent 25 years in the EMS revenue cycle management industry, prior to his retirement from Quick Med Claims. In addition to holding EMT credentials in Pennsylvania, he is also a Certified Ambulance Documentation Specialist via the National Academy of Ambulance Compliance. Humphrey is a periodic guest contributor to the QMC blog and podcast space.
