Table of Contents

SCT and Hospice Transport Survey

Medicare Secondary Payer -- Correction
by David M. Werfel, Esq.

Stars of Life Sponsors

AAA News Clipping Service

AAA Faces and Spaces Audio Conference

Pictures From Hurricanes Katrina and Rita Needed

ASM 2006 Summer Session

SCT and Hospice Transport Survey

The AAA will be meeting with officials with the Centers for Medicare and Medicaid Services (CMS) to discuss the downgrading of SCT claims to ALS as well as denials of SCT claims. However, we need to gather data on the extent of the problem before approaching CMS officials. It therefore would be greatly appreciated if you would take a few minutes to complete our brief web-based survey on SCT and hospice transports.  To access the survey, go to http://www.zoomerang.com/survey.zgi?p=WEB22595SXPL3R.

If you are not the appropriate individual with your organization to complete the survey, please forward this e-mail to a member of your billing staff so that he or she can complete it.   Please complete the survey by Wednesday, May 3.

Medicare Secondary Payer – Correction
By David M. Werfel, Esq.

I want to correct the information that was given to you in a March 31, 2006 Member Advisory.  At that time, I advised you that CMS published an Interim Final Rule on February 24, 2006 (effective April 25, 2006) removing the word “promptly” when you have a Medicare patient with a liability or workers compensation claim.

While CMS removed the word “promptly”, it did so only in some areas of the regulation and not others.  CMS has since issued Transmittal 49 (Change Request 4024) on April 7, 2006.  This Transmittal makes numerous changes to CMS Manual Pub. 100-05 (Medicare Secondary Payer), effective May 8, 2006.  However, these changes to the regulation and the Manual effectively make no change in CMS’ interpretation for billing Medicare Secondary Payer situations involving liability insurance, workers compensation or no-fault insurance.

At the outset, you must understand Medicare treats liability insurance (including a self insured plan for liability insurance that provides payment based on a legal liability) differently than no-fault and workers compensation.  The Regulation 42 C. F. R. 411.50(b) defines “liability insurance” as insurance based on a legal liability for injury, illness or property damage.  It includes, but is not limited to, auto liability, uninsured, underinsured, homeowners, malpractice, product liability and casualty insurance.  “No-fault” is defined as insurance that pays for medical expenses for injuries, regardless of who is at fault.  It can include auto, homeowners and even commercial plans.

The rules are different before vs. after 120 days, i.e. the period referred to by “promptly”.  During the 120 day period, liability, No-Fault and workers comp must be billed first.  If you have evidence they will not pay within the 120 day period, you can then bill Medicare for a conditional payment.  However, there is a distinction for liability claims as opposed to No-Fault or Workers Compensation.

If you billed liability insurance during this 120 day period and want to then bill Medicare as liability insurance will not pay within 120 days, you must withdraw the liability claim.  That rule does not apply for No-fault or workers compensation claims.  For no-fault and workers comp, you can “double-bill” Medicare and either No-Fault or workers comp.  If both pay, you would return to Medicare their conditional payment.

After the 120 day period, for liability, you must choose one or the other - - either stay with the liability claim or bill Medicare (keep in mind, you can bill Medicare 15-27 months after the date of service, although there is a penalty for claims billed after one year), but if you choose to bill Medicare, then you must withdraw all claims for the liability insurance.  If you choose to pursue Medicare, then you are locked in to the Medicare allowable and can not bill the patient, except for co-insurance, deductible and for non-covered charges.  If you choose to pursue the liability payment, you can collect the full billed charges.

Please note, the rules are different in Oregon, as a result of a Court decision.  In Oregon either liability insurance or Medicare may be billed in the first 120 days, but after the 120 days you must bill Medicare and the liability claim must be withdrawn.

Except in Oregon (as noted above), in these situations, it is the position of CMS that you bill as follows:

1. Bill the liability insurance, No-Fault or Workers Compensation insurance first.
2. If they indicate that they will not pay within 120 days, you then have a choice, depending on the payer:

a. If liability insurance, either stay with them or bill Medicare and withdraw the liability claim.
b. If No-Fault or Workers Compensation, bill Medicare for a conditional payment.

1. If it is liability insurance, and you billed Medicare, did not withdraw the liability claim and liability insurance paid, you are locked in to the Medicare allowable.  Refund to Medicare what it paid.  You may keep any unpaid deductible and co-insurance, plus any charges for non-covered services.  Send the rest to the beneficiary.
2. If it is No-Fault or Workers Compensation and both the No-Fault/Workers Compensation and Medicare pay, submit an adjustment to Medicare.  Medicare will make any adjustments necessary.

Please note, the AAA does not agree with the position taken by CMS as it is not in accord with that we believe to be Congressional intent, i.e. that Medic is secondary whenever possible.  The A.A.A. has notified CMS accordingly.  However, it will take additional action by CMS (e.g. opening up the regulations for proposed changes in the future) or Congress to revise CMS’ current interpretation.

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AMERICAN AMBULANCE ASSOCIATION
presents



Faces and Spaces - Audio Conference

Wednesday, May 24, 2006 f  3:00 p.m. – 5:00 p.m. (EST)
Presented by:
Jon Swanson, Executive Director
Metropolitan Emergency Medical Services  
  
Learn to predict trends in staffing and an effective means of retention calculation

Faces and Spaces is a basic introduction to a methodology for:

• Learning to predict your staffing needs

• Defining and counting the number of people currently employed.

• Tracking and calculating your turnover rate

Sign up today for the audio conference using the attached registration form!

Please Note:  Questions should be sent by e-mail to AAA Manager of Member Services and Public Affairs Stacy Bromley at sbromley@the-aaa.org.

 © Copyrighted: AAA 2006 – The use of language contained within this document is prohibited without first the consent of the American Ambulance Association.

Pictures From Hurricanes Katrina and Rita Needed

As we are looking forward to the Stars of Life Event in Washington, DC, we remember the work that members did to assist in affected areas in the aftermath of Hurricanes Katrina and Rita. The AAA would like you to send pictures or videos of your crews in action that we may with use at the Stars of Life Banquet.

We need all photos by COB Monday, April 24, 2006. Please send any images you may have to: edavis@the-aaa.org

ASM 2006 SOLD OUT!

Now accepting enrollment for a special 2006 summer session of the Ambulance Service Manager (ASM) Program.  Reserve your place today!

2006 Ambulance Service Manager (ASM)
The ASM Program is sponsored by the American Ambulance Association (AAA) and is for aspiring, new, and experienced managers who wish to develop their leadership competencies and sharpen essential management skills.  The program provides a broad foundational curriculum matching cutting edge management theory with real-life practical applications.

The ASM Program is a certification course designed to immerse participants in an engaging learning cohort.  A small group of 40 participants moves together through two weeks of face-to-face instruction and experiential learning led by industry leading faculty bridged by several weeks of online discussion and group project work.

ASM Graduates will:

• Develop 41 competencies essential to contemporary leaders managing sustainable EMS Organizations.
• Build problem solving skills through real life case studies, group work, and an industry specific team research project.
• Appreciate principles of system design, operational efficiency, and performance management.
• Demystify the complexities of finance, budgeting, and the ever evolving reimbursement landscape.
• Learn cutting edge practices and theories including appreciative inquiry, emotional intelligence, and other human relations innovations.
• Engage industry leaders as they present current trends in EMS including system design, technology, best practices, and what the future holds.

Dates for the 2006 program are:

• Online begins June 21, 2006
• Onsite week 1: July 20-25, 2006
• Onsite week 2: September 7-12, 2006

Questions?  Call Sharon Conroy at (816) 431-2600.

Go to http://www.fitchassoc.com/Services/conferences.htm to download the brochure and registration materials. http://www.fitchassoc.com/

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