WEBCAST ~ 01/18/2012 01:00 PM Eastern Standard Time REGISTER

This webcast from JEMS will be presented by Steve Wirth and Doug Wolfberg and will focus on essential documentation points you need to cover with no-transport situations.  Whenever you don’t transport a patient, it’s essential to follow an established protocol to ensure that your biases and other subjective factors don’t take over when you’re dealing with the patient. And the quality of your documentation may be what helps save you in the event of a lawsuit.

Doug and Steve have years of experience in the field and in dealing with these situations from the legal side as well. Their firm represents hundreds of EMS agencies of all types across the nation. Don’t miss this valuable and practical webcast!

Register today and learn what has become easier for field providers and what you still need to be diligent about as an EMS professional.

Doug Wolfberg and Steve Wirth are attorneys with Page, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s website at www.pwwemslaw.com for more EMS law information.

MAXimize Ambulance Billing Inc.

During the most recent holiday season — the season of giving — the Centers for Medicare & Medicaid Services (CMS) actually gave what could be construed as a holiday gift by taking something away.

On Dec. 28, 2011, CMS announced that it was delaying what many thought would be a contentious issue — the prepayment review demonstration. In the same announcement, CMS said it also was delaying the implementation of the Prior Authorization of Power Mobility Devices (PMDs) demonstration. The agency hastened to add that the Part A-to-Part B rebilling demonstration would remain as scheduled and would begin on Jan. 1, 2012.

Citing the fact that it had received many comments about both demonstration programs, the agency said that it would “consider these comments carefully” and that it would provide “at least 30 days notice before the demonstrations begin.”

The Pile-on

Among those who were challenging CMS on the two issues were 24 members of Congress, including veteran U.S. Reps. Charles Rangel (D-NY) and physician Michael C. Burgess (R-TX). In a Dec. 15, 2011 letter to acting CMS Administrator Marilyn Tavenner, the representatives cited efforts Congress made last year to reduce pricing for powered mobile devices (PMD) while at the same time increasing program integrity requirements for Medicare suppliers.

“On January 1, 2011, Congress mandated that all Medicare Group 2 standard power wheelchairs be converted to a 13-month rental item requiring businesses to obtain substantial outside capital,” the representatives wrote. “Including a demonstration project to the requirements in place could harm seniors that depend on durable medical equipment to live independently in their own homes.”
“We encourage you to halt the prepay review demonstration project due to the potential threats to businesses, jobs and seniors’ access care,” the letter read.
The correspondence appeared to lump the PMD prepayment demonstration with the inpatient Recovery Audit Prepayment Review demonstration.

On Dec. 29, 2011, the American Association of Homecare posted a news alert stating that, as a result of “intensive collaboration” with CMS and its organization (AAHomecare), CMS elected to delay the PMD demonstration. In its news alert, AAHomecare’s vice president of government affairs, Walt Gorski, was quoted as saying “we are pleased that CMS has taken a deep breath to better understand the power mobility sector and the impact that any widespread prepayment review would have on Medicare beneficiaries and homecare providers.”

The news alert stated that, when the program was announced by CMS on Nov. 15, 2011, the association began working with its members, physicians, consumers and members of the Complex Rehab and Mobility Council (CRCM) who would have been affected by the demonstration.

Prior Authorization for PMDs

According to CMS, the Prior Authorization would affect scooters and power wheelchairs for Medicare beneficiaries in seven states the agency previously has identified as having large numbers of fraud- and error-prone providers: California, Illinois, Minnesota, New York, North Carolina, Florida and Texas. This demonstration, CMS noted, would have helped to ensure that a beneficiary’s medical condition would warrant their medical equipment falling under existing coverage guidelines. Moreover, the program would assist in preserving a Medicare beneficiary’s right to receive quality products from accredited suppliers, the agency said.

Prepayment Review Demonstration

As described by CMS, the Recovery Audit Prepayment Review would have allowed the RACs to review claims before they were paid to ensure that providers had complied with all Medicare payment rules. The RACs then would have conducted prepayment reviews on certain types of claims that historically have resulted in high rates of improper payments.

In addition to the aforementioned California, Illinois, New York, Florida and Texas, CMS noted that these reviews also would have focused on the state of Louisiana. The agency also identified four states with high claims volumes of short inpatient hospital stays, naming Pennsylvania, Ohio, North Carolina and Missouri. A total of 11 states had been targeted for the demonstration, which since has been delayed until further notice.

“Considering the amount of time it takes to get to the Administrative Law Judge (ALJ) level of appeal — well over a year— it is good that the program is delayed,” Andrew Wachler, Esq., principal of Wachler & Associates, told RACmonitor. “And that’s because (of) the effect that prepayment review has on a hospital’s cash flow.”

This article was written by Chuck Buck    and other articles like it can be found on RAC Monitor.

CMS Will Delay Enforcement of 5010 Standards Compliance

Update courtesy of Page, Wolfberg & Wirth

On November 17, 2011, CMS announced a 90-day enforcement “grace period” for compliance with the new HIPAA 5010 transaction and code set standards.  This means that CMS will not initiate enforcement action against providers that are not in compliance with the 5010 standards until Saturday, March 31, 2012.

This is welcome news for many providers that are rushing to ensure they are ready for the transition at the end of this year.  Ambulance services that engage in covered electronic transactions, like claim submissions, are required to begin using the new 5010 standards as of January 1, 2012.  The new standards will enable providers to transition from the current ICD-9 codes to the new ICD-10-CM codes in October of 2013.

Despite the enforcement delay, CMS emphasizes that the official compliance date for use of the new standards remains Sunday, January 1, 2012.  At our upcoming spring abc3 conferences, PWW will discuss what the transition to ICD-10 codes will mean for the ambulance condition codes and discuss effective solutions your service will need to prepare for the switch to ICD-10 .

Click HERE to discover what late-breaking topics will be covered at spring abc3 and to register for this exciting event.

AHA conducted site visits and interviewed leaders at NovantHealth in North Carolina, Piedmont Health in Georgia and Banner Health in Arizona.

Read more: Top hospitals share recipe for success – FierceHealthcare http://www.fiercehealthcare.com/story/top-hospitals-share-recipe-success/2011-06-06#ixzz1OnNdxnP3

To say that the Galloway Township Ambulance Squad is busy is to understate the reality.

The squad of 49 paid professionals and three volunteers, all qualified EMTs, use their five ambulances to make approximately 5,000 calls a year. Of that number, they average 60 percent of their calls to motor vehicle accidents and 40 percent to health-related calls and emergencies

(Reuters Health) – The number of emergency rooms has dropped by more than a quarter over the past two decades, while patient visits have kept rising, researchers said Tuesday.

The result is overcrowded ERs that can’t provide optimal care for their patients, according to the new findings, published in the Journal of the American Medical Association.

“This is a continuously deteriorating situation,” said Dr. Renee Hsia, an emergency physician at the University of California, San Francisco, who worked on the study. “It’s a threat to everyone’s care.”

In the first study of its kind, Hsia and her colleagues used data from the American Hospital Association to track which hospitals closed or opened ERs across the nation.

From 1990 through 2009, they saw a drop from 2,446 to 1,779 urban ERs, corresponding to 27 percent.

“That’s a huge number,” Hsia told Reuters Health. “When you look at ER visits over the same time period, there was a 35-percent increase.”

ERs are the only part of the U.S. healthcare system required to treat all patients, regardless of whether they can pay. But hospitals aren’t required to have an ER, Hsia said, so that is a natural place to look for savings when the economy is tight.