Several notable changes have been initiated under the 2016 Physician Fee Schedule Final Rule for Ambulance Services on November 16, 2016.

Change in bonus payment extensions

The Medicare ambulance fee schedule amounts for ground ambulance services, which were last increased in July 2008, have now been extended further through December 31, 2017. Section 203 extends the provision by increasing the amounts from the Ambulance Fee Schedule in

• 2% for land transport originating in urban areas
• 3% for land transport originating in rural areas
• 22.6% for ground transportation originating from an area that is within the lowest 25th percentile of all rural areas ordered by population density, known as super-rural areas

All three of these provisions will expire on December 31, 2017, unless Congress decides to extend them beyond that date.

Zip Code Change Affecting Refunds

For the purpose of the ambulance fee schedule, CMS introduced the zip code changes that took effect on January 1, 2015. However, the geographic designations for approximately 95.22 percent of zip codes remain unchanged.

Why is this important?

Changes in zip codes from urban to rural and from rural to urban will have an impact on billing refunds, especially for rural pickups.

CMS increases the mileage rate by 50 percent for each of the first 17 miles and the rural bonus is 3%.

• More zip codes have changed from rural to urban (1,600 or 3.73 percent) than from urban to rural (451 or 1.05 percent)
• The state of Ohio has the most zip codes that changed from urban to rural with a total of 54, or 3.63 percent of all zip codes in the state.
• The state of West Virginia has the most ZIP codes that changed from rural to urban (149 or 15.92 percent of all ZIP codes in the state).

And for air ambulance services

When the collection point is in a rural area, the total payment (base rate and mileage rate) increases by 50%. Therefore, if a collection point (POP) zip code changes from rural to urban, an ambulance service receives less reimbursement from Medicare (and vice versa if a POP zip code changed from urban to rural).

Changes in the regulation of ambulance personnel

All ambulance transports must be attended by at least two people who must comply with the requirements of applicable state and local laws where services are rendered, and current Medicare requirements.

For Basic Life Support Vehicles (BLS), at least one of the staff must be certified as a minimum Basic Emergency Medical Technician (EMT-Basic).

BLS Definition Review: Basic Life Support (BLS) means ground ambulance vehicle transportation and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be manned by a person who is qualified under state and local laws as a Basic Emergency Medical Technician (EMT-Basic). These laws can vary from state to state. For example, only some states allow an EMT-Basic to operate limited equipment on board the vehicle, assist more qualified personnel with assessments and interventions, and establish a peripheral intravenous (IV) line. This has now been removed as CMS states that they may not accurately reflect the status of relevant state laws over time.

Note: The reduction for non-emergency BLS rides to and from dialysis treatment facilities effective October 1, 2013 is not reflected in the Ambulance Fee Schedule Public Use File. The 10% reduction is taken at the time of payment of the claim.