The new model now requires providers to get prior authorization (PA) before scheduling a non-emergent ambulance transport for a patient and pays ambulance services for taking patients to non-hospital facilities.
A ride in an ambulance can cost between hundreds and thousands of dollars depending on locations, services and the contractual agreements between providers and payers. They’re also a major contributor to surprise out-of-network bills. The CMS program measuring improper Medicare payments consistently pegs ambulance services in the top 20 services with improper payments, according to Healthcare Dive. An estimated 22.6% and 18.6% of non-emergent ambulance transport payments were improper in 2017 and 2018, respectively.
CMS announced it will expand the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) nationwide. The model has saved Medicare about $650 million over four years while preserving quality of care and access to essential services. The RSNAT Prior Authorization Model tests whether PA helps save Medicare money while maintaining or improving the quality of care for repetitive, scheduled non-emergency ambulance transportation. These services are covered under Medicare Part B for Medicare beneficiaries who need to ride in an ambulance to certain medical appointments, according to CMS.gov. With the expansion of this model, CMS claims it intends to focus on results and ensure that the right payments are made at the right time for the right beneficiary for covered, appropriate and reasonable services.
CMS Administrator Seema Verma said,
When deployed appropriately, prior authorization can help ensure Medicare requirements are met before a service is provided and the claim is paid, without creating any new documentation requirements for providers. The RSNAT model has proven a resounding success, and beneficiaries across the country deserve to benefit from it.
CMS is continuing to monitor the COVID-19 Public Health Emergency and will take that into account when determining the timeframe for expansion of this program into additional states. Overall, CMS said the model reduced the scheduled transports by 63% and related expenses by 72% for Medicare beneficiaries with end-stage renal disease or severe pressure ulcers. All the model’s current participants will continue to participate in the model past the original end date of December 1. They include Delaware, Maryland, New Jersey, Pennsylvania, North Carolina, South Carolina, Virginia, West Virginia and Washington, D.C, according to Modern Healthcare.