January 7, 2004


Table of Contents

CMS Announces Town Hall Meeting on Condition Codes

Potential Ambulance Overpayments - Florida Only by David M. Werfel, Esq.

January 6, 2004 Issue of DHS Today

AAA Winter Healthcare Reimbursement & Human Resources Conference
Miami Beach, Florida - January 28-31, 2004



CMS Announces Town Hall Meeting on Condition Codes

On December 22, 2003, the Centers for Medicare and Medicaid Services (CMS) issued a notice in the Federal Register announcing a Town Hall Meeting on a set of condition codes specific to ambulance services. While there are still a number of hurdles to clear before the condition codes can be implemented, we view the announcement of the meeting as an enormous success for the AAA and its members who have advocated tirelessly for a set of codes specific to ambulance services. The Town Hall Meeting will be held at CMS headquarters in Baltimore, Maryland on February 4, 2004. The meeting is open to all interested parties but unlike the Open Door Forums, there will be no way to participate by teleconference. The Federal Register notice announcing the Town Hall Meeting is attached as an Adobe Acrobat file. To register for the meeting and download the condition codes, please access the CMS website: www.cms.hhs.gov/paymentsystems.



Potential Ambulance Overpayments - Florida Only

by David M. Werfel, Esq.

Ambulance suppliers in Florida received a 12/2/03 Special Bulletin on the Carrier website. The Special Bulletin indicated that the Carrier, First Coast, has made overpayments and is in the process of calculating the amounts. Further, some suppliers have noticed a change in their allowable rates for services in the past two months.

As a result of the above, I have contacted First Coast to determine the cause of the problem, who is handling this project, etc.

Debra Lowery-Williams will be the point person on this issue.

Several companies have indicated that they did not get their disclosure report for 2003. Any company who did not receive the report should contact Debra Lowery-Williams for it. She will put in the request and have the report sent to them. Her number is (904) 791-8533.

At this time, First Coast does not know who is impacted by the incorrect calculation of the rates. There are 238 ambulance providers who bill First Coast in Florida.

First Coast is in the process of calling all ambulance suppliers who bill Part B to ensure they are aware of the overpayment issue and to verify the address. I have been told that, at least one person calling for First Coast, is advising companies the overpayments will be offset from early January Remittance Notices. If this is what you heard--ignore it.

In a few days they will send the 2003 Disclosure reports to all ambulance suppliers. It is easier for First Coast to send them all out at the same time due to their otherwise having to manually match profile reports and address labels.

When you get the Disclosure report, you will then be able to figure out if you are affected. The report will give you the 2003 reasonable charge, including the IIC.

For each service, multiply that by 60%. You should already have the fee schedule amount for your area (if not, it is on the First Coast website). Take 40% of that figure for your locality. If that total is the same as what they have been allowing for the past two months or so, you have no problem.

If they have been allowing more, there will be an overpayment.

What caused the problem is a little technical. It comes down to their computer system not updating the old codes when we switched from the old codes to the new codes (that went into effect 1/1/01 and the Q-Codes that went into effect 4/1/02). Since the allowables during the phase in are based in part on the reasonable charge, they had to update these codes each year.

On 9/28/03 they fixed the system and corrected the rates. Those impacted will know it simply by looking at Remittance Notices that list dates of service after 9/28.

First Coast has made a request for their system to extract the data as to which providers are affected and the amounts of their overpayments. That data will not be ready until 12/23. Realistically, given the proximity of that date to Christmas and then the week between Christmas and New Years Day, no one should receive a notice of any overpayment in December.

What affected companies should do now are:

1. Most importantly, do not panic. Nothing will happen for a while, no one will be asked right away to pay it back, even then some things can be negotiated.
2. Make sure you have the profile reports for 2002 (Jan-March) and 2003.
3. Calculate what you think the correct rates should have been. Then compare that to what is listed in Remittance Notices for dates of service since 9/28/03.
4. DO NOT GO RUNNING TO ELECTED OFFICIALS. It is not needed, certainly at this time, and may back-fire in a big way against those companies.
5. Wait to see what the Carrier calculates as the overpayment. It would not hurt to calculate it yourself.
6. Avoid the rumors. One company told me it only affected the Q-codes. That is not true. I heard another thought they would get paid more. Not likely.



OSHA Delays Enforcement of Respiratory Protection Rule Provisions on TB

OSHA Trade Release
January 14, 2004
Contact: Bill Wright
Phone: (202) 693-1999

OSHA Delays Enforcement of Respiratory Protection Rule Provisions
Six month phase-in covers workers with potential exposure to tuberculosis

WASHINGTON -- The Occupational Safety and Health Administration (OSHA) announced today that it will delay until July 1, 2004, enforcing several provisions of the respiratory protection standard for establishments required to provide respirators for protection from potential exposure to tuberculosis.

The announcement of the six-month period to allow affected employers to come into compliance with the additional requirements, follows OSHA's withdrawal last month of its 1997 proposal on tuberculosis and the revocation of a separate respiratory protection standard for workers exposed to TB.

"Requirements such as annual fit testing and medical evaluations for covered employees may be new for some employers," said OSHA Administrator John Henshaw. "We want to make sure they are aware of these new requirements and give them every opportunity to be able to successfully come into compliance."

With the withdrawal of the TB rule, OSHA announced it would begin applying the general industry respiratory protection standard for protection against the disease. This rule includes several requirements which were not as detailed in the revoked rule, such as updating the facility's respirator program, medical evaluation requirements, annual fit testing of respirators, and some training and recordkeeping provisions. During this six month period, OSHA will not cite these new requirements for establishments with workers exposed only to tuberculosis. All elements of the revoked rule continue to be enforced under the corresponding elements of the current respiratory protection standard.

To meet the requirements of the agency's respiratory protection standard, employers will need to revise their respiratory protection program, conduct annual respiratory fit testing, and perform a medical evaluation and annual training for employees using respirators.

This announcement does not affect establishments already covered under the respiratory protection rule where there is exposure to hazardous substances other than tuberculosis. All provisions of the rule will continue to be applied to those employers.

OSHA is dedicated to assuring worker safety and health. Safety and health add value to business, the workplace and life. For more information, visit www.osha.gov.


January 6, 2004 Issue of DHS Today

Attached as a Microsoft Word file, is the most recent issue of DHS Today which is a weekly publication by the Department of Homeland Security of their news, press releases and events.


2004 Winter Healthcare Reimbursement & Human Resources Conference

Miami Beach, Florida - January 28-31, 2004

The AAA's Winter Conference is two months away... the conference will be at the luxurious Wyndham Miami Beach Resort in the heart of South Beach, Miami Beach Florida. This conference will feature two separate tracks; one focusing on Medicare Reimbursement and a new track for Human Resources.

Attendees will receive the latest updates on Medicare and Medicaid Reimbursement, ambulance condition codes, ambulance relief in the Medicare Prescription Drug Bill and HIPAA compliance issues. Also, you can expect to learn the best practices for Human Resources with topics to include; employee recruitment and retention, employee/employer retirement plans, and employee assistance programs.

Register early & SAVE! Early Bird Registration ends January 14, 2004!

For more information and to register download the
Winter Healthcare Reimbursement & Human Resources Conference brochure
by clicking here (pdf document)

For Further Information contact:
Erika Davis
Manager of Meetings and Education
American Ambulance Association
E-mail: [email protected]