On November 16, 2016, several notable changes were initiated under the 2016 Medical Fee Schedule Final Rule for Ambulance Services.

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 further extended through December 31, 2017. Section 203 extends the provision that increases Ambulance Fee Schedule amounts in

• 2% for ground transportation originating in urban areas
• 3% for ground transportation originating in rural areas
• 22.6% for ground transportation originating in an area that falls within the lowest 25th percentile of all rural areas ordered by population density, known as superrural 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 purposes of the ambulance fee schedule, CMS introduced the ZIP code changes effective January 1, 2015. However, the geographic designations for approximately 95.22 percent of ZIP codes remain unchanged.

Why is this significant?

Changes in zip codes from urban to rural and rural to urban will impact billing reimbursements, 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 have changed from rural to urban (149 or 15.92 percent of all ZIP codes in the state).

And for air ambulance services

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

Changes in the ambulance staff regulations

All ambulance transportation must be attended by at least two persons who must meet the requirements of applicable state and local laws where services are provided and current Medicare requirements.

For Basic Life Support (BLS) vehicles, at least one crew member must be certified as a minimum Emergency Medical Technician Basic (EMT-Basic).

BLS Definition Revision: Basic Life Support (BLS) means transportation in a ground ambulance vehicle and medically necessary services and supplies, in addition to the provision of BLS ambulance services. The ambulance must be manned by a person who is qualified under state and local law as an Emergency Medical Technician (EMT-Basic). These laws may vary from state to state. For example, only a few states allow an EMT-Basic to operate limited in-vehicle equipment, help more qualified personnel perform evaluations and interventions, and establish a peripheral intravenous (IV) line. This has now been removed because CMS states that it may not accurately reflect the status of relevant state laws over time.

Note: The reduction for non-emergency BLS transportations to and from dialysis treatment facilities that became effective October 1, 2013 is not reflected in the public use file of the ambulance fee schedule. The 10% reduction is taken at the time of claim payment.