May 6, 2021
Compliance News, EMS Compliance News
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As you are likely aware by now, Medicare has issued a waiver providing for reimbursement of ground ambulance services without transport under specific situations. The waiver applies to emergency ground ambulance services in response to a 911 or equivalent call in which a transport that would have been medically necessary, but did not occur due to a community-wide EMS protocol resulting from the COVID-19 pandemic. You should talk with your billing department or billing provider about the billing and reimbursement processes involved.
There is a critical compliance aspect of this COVID-19 related waiver that you should be aware of. Typically, an ambulance provider or supplier waiving or discounting beneficiary cost-sharing obligations resulting from ground ambulance services paid for by the Medicare program would implicate the Federal anti-kickback statute and be cause for concern of False Claims Act violations. However, the OIG issued guidance on May 5, 2021 that, under this specific waiver, you should not collect the cost-sharing amount from the patient. Here are two questions and answers from yesterday’s announcement: “Fact Sheet – Waiver for Ground Ambulance Services: Treatment in Place”
Do I Have to Collect the Patient’s Cost-sharing Amount?
At HHS Office of Inspector General (OIG) FAQ, the OIG provides guidance about ambulance provider or supplier collection of patient cost-sharing amounts applicable to services to which this waiver applies.
What if I Already Collected Payment from the Medicare Patient?
If you previously collected payment from a patient for services that Medicare now covers under the waiver, you must refund any amounts paid that are more than the applicable cost sharing under the waiver.
The view the entire Fact Sheet, click here.
The Fact Sheet then directs us to the specific OIG guidance found here: What are the implications, under OIG’s administrative sanction authorities, of a ground ambulance provider waiving or discounting a patient’s cost sharing obligations (required by Medicare), resulting from ground ambulance services paid for by the Medicare program pursuant to a waiver under section 1135(b)(9) of the Social Security Act?
We are copying relevant sections of this guidance below. Again, you should discuss with your billing department or billing provider how they are handling patient cost-sharing obligations if you are seeking reimbursement under this waiver.
“While an ambulance provider or supplier waiving or discounting beneficiary cost-sharing obligations resulting from ground ambulance services paid for by the Medicare program under a waiver established pursuant to section 1135(b)(9) of the Social Security Act would implicate the Federal anti-kickback statute and Beneficiary Inducements CMP, OIG believes that such discounts or waivers would represent a sufficiently low risk of fraud and abuse under those statutes, provided the ground ambulance services are billed in accordance with the waiver described further below…..
In light of these EMS protocols, on May 5, 2021, pursuant to section 1135(b)(9) of the Social Security Act, the Secretary of Health and Human Services waived certain statutory requirements relating to Medicare payments for ground ambulance services furnished in response to a 911 call (or the equivalent in areas without a 911 call system) in cases in which an individual would have been transported to a destination permitted under Medicare regulations but such transport did not occur as a result of communitywide EMS protocols established due to the public health emergency (the Waiver). The Waiver is effective retroactively to Medicare claims for services rendered on or after March 1, 2020.”
5.6.2021
