This document provides Medicare payment data and summaries for ambulance services for fiscal year 2013. Key points include:
- Total Medicare payments for ambulance services in 2013 were $4.9 billion, a slight 0.2% decrease from 2012.
- Ground mileage and BLS non-emergency transports saw small increases in payments and volume from 2012 to 2013.
- Dialysis-related transports increased 6.15% in volume and 3.44% in payments from 2012 to 2013.
- Data is provided on national, state (Wisconsin), and dialysis transport levels. Recent Medicare rule changes and reports addressing ambulance utilization and payments are also summarized.
This document discusses cardiac arrest survival rates and efforts to improve outcomes. It notes that approximately 360,000 out-of-hospital cardiac arrests occur annually in the US, with a 90.5% mortality rate. The author then outlines changes made by the Wausau Fire Department between 2010-2014 to protocols, equipment, and tracking of cardiac arrest data that corresponded to improved survival rates, from 12-18% to 23.6% overall. Maintaining a statewide cardiac arrest data bank that collects standardized information from all services could further increase survival rates by allowing analysis of best practices.
This document summarizes Wisconsin's EMS program and provides updates from 2016. It outlines the number and types of EMS services and personnel in the state. It also reviews statewide call volumes from 2013 to 2016. The EMS section is described as having 7 staff members who license approximately 783 services and over 18,000 providers. Information is provided on the EMS website, WARDS data system, funding assistance program, licensing renewals, and E-Licensing. Healthcare coalitions and the EMS board are also summarized.
PSOW 2016 - Community Paramedicine in WisconsinPSOW
This document discusses the community paramedicine program in Wisconsin. It provides an overview of community paramedicine and how it can help improve healthcare access, coordination of care, and reduce costs. It then summarizes pilot programs in Wisconsin that showed reductions in emergency department visits and hospital admissions for patients engaged with community paramedics. The document concludes by outlining the legislative process to establish community paramedicine in Wisconsin law and lists some pioneering community paramedicine programs already operating in the state.
The document provides an update from the Wisconsin Department of Health Services Emergency Medical Services program. It summarizes the program's mission to ensure high quality pre-hospital emergency care statewide. It also provides statistics on the number of EMS services, personnel, and calls in Wisconsin. Additionally, it reviews the program's activities over the past year, upcoming renewals, and future plans.
The document summarizes a community paramedic pilot program between the South Area Fire District and Wausau Fire Department. The program aimed to reduce preventable hospital readmissions through home visits by paramedics within 48-72 hours of discharge. Initial results found lower than national readmission rates for heart failure, COPD and pneumonia patients, as well as high patient satisfaction ratings. The program demonstrated the potential for community paramedics to improve outcomes and lower healthcare costs through post-discharge support in the home.
Sophisticated Prehospital Stroke Systems of CarePSOW
1. Kerry Ahrens discusses the importance of building a stroke system of care in Wisconsin to improve patient outcomes through faster treatment times.
2. Stroke is a leading cause of disability and costs $34 billion annually in the US. Building regional stroke systems can help optimize patient care through protocols to administer tPA within 30 minutes and transfer patients with large vessel occlusions to interventional centers within 90 minutes.
3. Effective collaboration between EMS, hospitals, and healthcare agencies is essential to establish standardized processes and monitor performance metrics to continually improve the efficiency of stroke care delivery.
This document summarizes the Wisconsin EMS system and recent updates. There are over 16,000 EMS professionals in Wisconsin, serving 772 EMS services. Statewide call volume has increased yearly between 2013-2015. The EMS section oversees EMS licensure and provides resources through its website. National EMS practice transitions are underway, and the state is working to update rules and statutes to align with national standards.
This document outlines best practices for pre-hospital and emergency room care of acute stroke patients presented by Dot Bluma and Cathy Etter. It discusses the importance of partnership between EMS and hospitals, describes challenges and strategies for meeting pre-hospital stroke care guidelines, and reviews recommendations from the American Stroke Association and Coverdell program. Statistics on stroke incidence and costs are also presented.
This document discusses cardiac arrest survival rates and efforts to improve outcomes. It notes that approximately 360,000 out-of-hospital cardiac arrests occur annually in the US, with a 90.5% mortality rate. The author then outlines changes made by the Wausau Fire Department between 2010-2014 to protocols, equipment, and tracking of cardiac arrest data that corresponded to improved survival rates, from 12-18% to 23.6% overall. Maintaining a statewide cardiac arrest data bank that collects standardized information from all services could further increase survival rates by allowing analysis of best practices.
This document summarizes Wisconsin's EMS program and provides updates from 2016. It outlines the number and types of EMS services and personnel in the state. It also reviews statewide call volumes from 2013 to 2016. The EMS section is described as having 7 staff members who license approximately 783 services and over 18,000 providers. Information is provided on the EMS website, WARDS data system, funding assistance program, licensing renewals, and E-Licensing. Healthcare coalitions and the EMS board are also summarized.
PSOW 2016 - Community Paramedicine in WisconsinPSOW
This document discusses the community paramedicine program in Wisconsin. It provides an overview of community paramedicine and how it can help improve healthcare access, coordination of care, and reduce costs. It then summarizes pilot programs in Wisconsin that showed reductions in emergency department visits and hospital admissions for patients engaged with community paramedics. The document concludes by outlining the legislative process to establish community paramedicine in Wisconsin law and lists some pioneering community paramedicine programs already operating in the state.
The document provides an update from the Wisconsin Department of Health Services Emergency Medical Services program. It summarizes the program's mission to ensure high quality pre-hospital emergency care statewide. It also provides statistics on the number of EMS services, personnel, and calls in Wisconsin. Additionally, it reviews the program's activities over the past year, upcoming renewals, and future plans.
The document summarizes a community paramedic pilot program between the South Area Fire District and Wausau Fire Department. The program aimed to reduce preventable hospital readmissions through home visits by paramedics within 48-72 hours of discharge. Initial results found lower than national readmission rates for heart failure, COPD and pneumonia patients, as well as high patient satisfaction ratings. The program demonstrated the potential for community paramedics to improve outcomes and lower healthcare costs through post-discharge support in the home.
Sophisticated Prehospital Stroke Systems of CarePSOW
1. Kerry Ahrens discusses the importance of building a stroke system of care in Wisconsin to improve patient outcomes through faster treatment times.
2. Stroke is a leading cause of disability and costs $34 billion annually in the US. Building regional stroke systems can help optimize patient care through protocols to administer tPA within 30 minutes and transfer patients with large vessel occlusions to interventional centers within 90 minutes.
3. Effective collaboration between EMS, hospitals, and healthcare agencies is essential to establish standardized processes and monitor performance metrics to continually improve the efficiency of stroke care delivery.
This document summarizes the Wisconsin EMS system and recent updates. There are over 16,000 EMS professionals in Wisconsin, serving 772 EMS services. Statewide call volume has increased yearly between 2013-2015. The EMS section oversees EMS licensure and provides resources through its website. National EMS practice transitions are underway, and the state is working to update rules and statutes to align with national standards.
This document outlines best practices for pre-hospital and emergency room care of acute stroke patients presented by Dot Bluma and Cathy Etter. It discusses the importance of partnership between EMS and hospitals, describes challenges and strategies for meeting pre-hospital stroke care guidelines, and reviews recommendations from the American Stroke Association and Coverdell program. Statistics on stroke incidence and costs are also presented.
PSOW 2016 - WI EMS/Trauma Medical Director ReportPSOW
Suzanne Martens provides a medical director report on EMS/Trauma activities in Wisconsin. She discusses revisiting the concept of a just culture that balances accountability with good intent. As medical director, her activities include advising various EMS councils and committees, reviewing protocols, and investigating a dozen cases. Her latest project is developing additional training for EMRs to administer IM epinephrine for anaphylaxis. Future projects include further protocol edits, defining new EMS roles, and improving data collection and resources.
The document discusses fraud and Medicare compliance. It provides an overview of the legal framework around governmental oversight of Medicare fraud by agencies like OIG, DOJ, and CMS. It also discusses additional oversight groups like ZPICs and RACs. Laws around fraud are explained, including the Anti-Kickback Statute and False Claims Act. Recent fraud cases are summarized involving ambulance companies billing Medicare for unnecessary transports. The presentation concludes with guidance on developing an effective compliance program with basic elements like training, monitoring, and responding to detected issues.
This document discusses the potential for community paramedics to help address various healthcare issues in rural communities. It summarizes the goals of establishing a community paramedic program, including decreasing hospital readmissions and non-essential emergency department visits while improving patient outcomes and reducing overall healthcare costs. The document also outlines some of the challenges faced in establishing community paramedic programs and next steps for the future, including pursuing legislative initiatives and permanent funding models.
Kulis ANG, Alaska, conducted a rapid improvement event to develop a better flow for their individual medical readiness. We hope you enjoy this outbrief from that event.
Telehealth Services: Part B Provider Outreach and EducationVSee
Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker Series
Speaker: Carynne Godfrey
Title: Part B Provider Outreach and Education Representative
Organization: NORIDIAN HEALTHCARE SOLUTIONS LLC
More info at: vsee.com/conference
The document provides updates on several technical milestones and developments of the WAH-EMR system. It discusses 1) new usage monitoring and report generation functionality, 2) the piloting of a synchronized patient alert system via SMS to four RHUs, and 3) the development of a mobile midwife system to allow electronic data collection in the field and syncing to the RHU-based EMR. It also outlines plans for increased interoperability between the RHU system and other facilities like provincial hospitals and DOH systems.
The document summarizes ChathamHealthLink, a health information exchange program in Chatham County, Georgia. It was formed by the Chatham County Safety Net Planning Council in 2004 to improve access to and quality of healthcare for uninsured county residents. The program allows different healthcare providers using separate electronic medical record systems to securely share patient information through a central database. This reduces duplication of services, improves care coordination, and allows providers and the Council to track health outcomes and service trends across the safety net system. The goal is for ChathamHealthLink to eventually connect all area providers, hospitals, and behavioral health organizations using interoperable electronic records.
This document provides contact information for seven EPA program managers who work with different tribes in specific geographic regions. It then discusses several requirements for tribes regarding reporting water quality issues to EPA, including requirements to notify EPA within 24 hours of detecting E. coli in water samples or experiencing certain water system failures that could impact water quality. It provides examples of monitoring and reporting deadlines and emphasizes the responsibility of water systems to ensure data is submitted to EPA on time.
This document summarizes the key points from a presentation given by Buck Henderson on the 2002 Bioterrorism Act and requirements for water systems in Texas. The act requires all community water systems serving over 3,300 people to complete a Vulnerability Assessment and those between 50,000-100,000 people to submit theirs by December 2003. It also discusses the development of a Critical Infrastructure Protection Council in Texas to advise the governor on security issues. The presentation covers what should be included in a Vulnerability Assessment and an Emergency Response Plan, such as identifying critical system components, potential threats, and response procedures. It provides guidance on responding to security incidents through site investigation, sampling, and public health measures like boil water advisories
This document summarizes the Chemical Stockpile Emergency Preparedness Program (CSEPP) operated by Pueblo County, Colorado. CSEPP is a joint program of the U.S. Army and FEMA established under Public Law 99-145 to protect the public from potential chemical accidents at chemical stockpile storage sites. The program involves the U.S. Army, FEMA, state and local governments, and response agencies working together to prepare local jurisdictions through resources, training, exercises and public awareness activities. The document outlines Pueblo County's CSEPP capabilities across areas such as alert systems, communications, plans, equipment, training and public outreach, finding the county to be fully capable in its emergency prepared
The document outlines the 20 step process for coordinating an observership at Harvard Medical School Cornea Center of Excellence Programs. It involves collecting application materials from the potential observer, entering their information into tracking spreadsheets, setting up required health screenings and training, confirming placement with a preceptor, and providing support and orientation for the observer during their visit. The goal is to formally arrange observational experiences for individuals to learn about cornea research and clinical care.
Medicaid EHR Incentive Webinar - September 24, 2014MassEHealth
This document summarizes an event about updates to the Medicaid EHR Incentive Program. Nicole Bennett presented on important deadlines, the 2014 supporting documentation requirements, and the reconsideration, denial and appeals process. The goals were to review deadlines, provide program updates, and take provider questions. Important timelines discussed included the program year ending in 2014, EPs and EHs able to initiate participation through 2016, and incentive payments ending by 2021. Penalties for Medicare providers begin in 2015 if not meaningful EHR users.
This document contains a business plan to upgrade an existing health clinic in rural Ethiopia. The plan proposes expanding the clinic building to add more rooms and services. It estimates costs of around $51,000 for construction, medical equipment, and staff salaries for the first six months. The clinic aims to improve healthcare access for local residents and tourists by providing services like basic medical care, dental care, laboratory tests, family planning, and health education. If upgraded, the clinic expects to serve over 3,600 patients annually and create jobs in the community. The timeline outlines construction from May to September, equipping the clinic from September to October, and beginning services by November.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Improved Worker’s Performance through Embedded Medical Intelligence in Digita...MEASURE Evaluation
This document discusses improving health worker performance in Bangladesh through embedding medical intelligence in digitalized management information systems (eMIS) at primary health care facilities. The eMIS guides health workers to adhere to clinical standards through decision support systems. It allows real-time individual patient tracking and remote supervision. Analysis of detailed service records helps identify gaps for quality improvement. The eMIS increased referrals of high-risk pregnancies and newborns, helping provide continuum of care. The system is being expanded to more facilities nationwide and additional decision support functionalities.
Navigating the Post-Health Care Reform LandscapePSOW
The document discusses several changes occurring in the post-Affordable Care Act healthcare landscape. It describes the rise of Accountable Care Organizations which integrate hospitals and physicians to coordinate patient care. It also notes the trend of hospitals acquiring physician practices, making hospitals the dominant player. Health systems are merging into larger organizations and acquiring ancillary services like rehabilitation facilities. The document outlines the establishment of health insurance exchanges and details the availability of premium subsidies and cost-sharing reductions for lower-income individuals. It provides data on enrollment in exchanges and Medicaid expansion.
This document describes an EMS physician program called MD-1 that provides enhanced medical capabilities and physician oversight to prehospital emergency response. MD-1 is equipped with advanced life support equipment and deploys a Chevrolet Tahoe for responses. The program has integrated into the local EMS system through approvals and training. MD-1 physicians respond to requests from incident commanders and provide assistance to crews on medical calls, mass casualty incidents, and difficult extrications. Initial responses have included managing difficult airways, treating cardiac events, and providing support during blizzard conditions. Feedback from EMS crews has been positive about the additional medical resources and oversight provided by the MD-1 physicians.
Ketamine for Pre-Hospital Sedation in Excited DeliriumPSOW
This document discusses a study on the use of ketamine for prehospital sedation of patients experiencing excited delirium. The study aims to determine if ketamine is an effective and safe treatment option that allows emergency responders to control agitated patients and transport them for further care. The document outlines the goals, inclusion/exclusion criteria, procedures, and contact information for the Wisconsin ketamine study being conducted by Drs. Curtis and Cady.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
Wisconsin/Nicaragua Health Projects PartnershipPSOW
This document provides an overview of Partners of the Americas and the Wisconsin/Nicaragua partnership. It discusses how Partners originated from Eisenhower and Kennedy's initiatives to strengthen ties between the US and Latin America. Wisconsin and Nicaragua were paired due to common agricultural economies and geography. The Wisconsin/Nicaragua partnership focuses on community development projects in areas like agriculture, women's programs, health, youth, and humanitarian assistance. A major initiative involves shipping fire trucks and ambulances from Wisconsin to Nicaragua to assist local fire departments. The partnership aims to enhance quality of life through people-to-people exchange programs promoting cultural understanding and sustainable development.
PSOW 2016 - WI EMS/Trauma Medical Director ReportPSOW
Suzanne Martens provides a medical director report on EMS/Trauma activities in Wisconsin. She discusses revisiting the concept of a just culture that balances accountability with good intent. As medical director, her activities include advising various EMS councils and committees, reviewing protocols, and investigating a dozen cases. Her latest project is developing additional training for EMRs to administer IM epinephrine for anaphylaxis. Future projects include further protocol edits, defining new EMS roles, and improving data collection and resources.
The document discusses fraud and Medicare compliance. It provides an overview of the legal framework around governmental oversight of Medicare fraud by agencies like OIG, DOJ, and CMS. It also discusses additional oversight groups like ZPICs and RACs. Laws around fraud are explained, including the Anti-Kickback Statute and False Claims Act. Recent fraud cases are summarized involving ambulance companies billing Medicare for unnecessary transports. The presentation concludes with guidance on developing an effective compliance program with basic elements like training, monitoring, and responding to detected issues.
This document discusses the potential for community paramedics to help address various healthcare issues in rural communities. It summarizes the goals of establishing a community paramedic program, including decreasing hospital readmissions and non-essential emergency department visits while improving patient outcomes and reducing overall healthcare costs. The document also outlines some of the challenges faced in establishing community paramedic programs and next steps for the future, including pursuing legislative initiatives and permanent funding models.
Kulis ANG, Alaska, conducted a rapid improvement event to develop a better flow for their individual medical readiness. We hope you enjoy this outbrief from that event.
Telehealth Services: Part B Provider Outreach and EducationVSee
Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker Series
Speaker: Carynne Godfrey
Title: Part B Provider Outreach and Education Representative
Organization: NORIDIAN HEALTHCARE SOLUTIONS LLC
More info at: vsee.com/conference
The document provides updates on several technical milestones and developments of the WAH-EMR system. It discusses 1) new usage monitoring and report generation functionality, 2) the piloting of a synchronized patient alert system via SMS to four RHUs, and 3) the development of a mobile midwife system to allow electronic data collection in the field and syncing to the RHU-based EMR. It also outlines plans for increased interoperability between the RHU system and other facilities like provincial hospitals and DOH systems.
The document summarizes ChathamHealthLink, a health information exchange program in Chatham County, Georgia. It was formed by the Chatham County Safety Net Planning Council in 2004 to improve access to and quality of healthcare for uninsured county residents. The program allows different healthcare providers using separate electronic medical record systems to securely share patient information through a central database. This reduces duplication of services, improves care coordination, and allows providers and the Council to track health outcomes and service trends across the safety net system. The goal is for ChathamHealthLink to eventually connect all area providers, hospitals, and behavioral health organizations using interoperable electronic records.
This document provides contact information for seven EPA program managers who work with different tribes in specific geographic regions. It then discusses several requirements for tribes regarding reporting water quality issues to EPA, including requirements to notify EPA within 24 hours of detecting E. coli in water samples or experiencing certain water system failures that could impact water quality. It provides examples of monitoring and reporting deadlines and emphasizes the responsibility of water systems to ensure data is submitted to EPA on time.
This document summarizes the key points from a presentation given by Buck Henderson on the 2002 Bioterrorism Act and requirements for water systems in Texas. The act requires all community water systems serving over 3,300 people to complete a Vulnerability Assessment and those between 50,000-100,000 people to submit theirs by December 2003. It also discusses the development of a Critical Infrastructure Protection Council in Texas to advise the governor on security issues. The presentation covers what should be included in a Vulnerability Assessment and an Emergency Response Plan, such as identifying critical system components, potential threats, and response procedures. It provides guidance on responding to security incidents through site investigation, sampling, and public health measures like boil water advisories
This document summarizes the Chemical Stockpile Emergency Preparedness Program (CSEPP) operated by Pueblo County, Colorado. CSEPP is a joint program of the U.S. Army and FEMA established under Public Law 99-145 to protect the public from potential chemical accidents at chemical stockpile storage sites. The program involves the U.S. Army, FEMA, state and local governments, and response agencies working together to prepare local jurisdictions through resources, training, exercises and public awareness activities. The document outlines Pueblo County's CSEPP capabilities across areas such as alert systems, communications, plans, equipment, training and public outreach, finding the county to be fully capable in its emergency prepared
The document outlines the 20 step process for coordinating an observership at Harvard Medical School Cornea Center of Excellence Programs. It involves collecting application materials from the potential observer, entering their information into tracking spreadsheets, setting up required health screenings and training, confirming placement with a preceptor, and providing support and orientation for the observer during their visit. The goal is to formally arrange observational experiences for individuals to learn about cornea research and clinical care.
Medicaid EHR Incentive Webinar - September 24, 2014MassEHealth
This document summarizes an event about updates to the Medicaid EHR Incentive Program. Nicole Bennett presented on important deadlines, the 2014 supporting documentation requirements, and the reconsideration, denial and appeals process. The goals were to review deadlines, provide program updates, and take provider questions. Important timelines discussed included the program year ending in 2014, EPs and EHs able to initiate participation through 2016, and incentive payments ending by 2021. Penalties for Medicare providers begin in 2015 if not meaningful EHR users.
This document contains a business plan to upgrade an existing health clinic in rural Ethiopia. The plan proposes expanding the clinic building to add more rooms and services. It estimates costs of around $51,000 for construction, medical equipment, and staff salaries for the first six months. The clinic aims to improve healthcare access for local residents and tourists by providing services like basic medical care, dental care, laboratory tests, family planning, and health education. If upgraded, the clinic expects to serve over 3,600 patients annually and create jobs in the community. The timeline outlines construction from May to September, equipping the clinic from September to October, and beginning services by November.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Improved Worker’s Performance through Embedded Medical Intelligence in Digita...MEASURE Evaluation
This document discusses improving health worker performance in Bangladesh through embedding medical intelligence in digitalized management information systems (eMIS) at primary health care facilities. The eMIS guides health workers to adhere to clinical standards through decision support systems. It allows real-time individual patient tracking and remote supervision. Analysis of detailed service records helps identify gaps for quality improvement. The eMIS increased referrals of high-risk pregnancies and newborns, helping provide continuum of care. The system is being expanded to more facilities nationwide and additional decision support functionalities.
Navigating the Post-Health Care Reform LandscapePSOW
The document discusses several changes occurring in the post-Affordable Care Act healthcare landscape. It describes the rise of Accountable Care Organizations which integrate hospitals and physicians to coordinate patient care. It also notes the trend of hospitals acquiring physician practices, making hospitals the dominant player. Health systems are merging into larger organizations and acquiring ancillary services like rehabilitation facilities. The document outlines the establishment of health insurance exchanges and details the availability of premium subsidies and cost-sharing reductions for lower-income individuals. It provides data on enrollment in exchanges and Medicaid expansion.
This document describes an EMS physician program called MD-1 that provides enhanced medical capabilities and physician oversight to prehospital emergency response. MD-1 is equipped with advanced life support equipment and deploys a Chevrolet Tahoe for responses. The program has integrated into the local EMS system through approvals and training. MD-1 physicians respond to requests from incident commanders and provide assistance to crews on medical calls, mass casualty incidents, and difficult extrications. Initial responses have included managing difficult airways, treating cardiac events, and providing support during blizzard conditions. Feedback from EMS crews has been positive about the additional medical resources and oversight provided by the MD-1 physicians.
Ketamine for Pre-Hospital Sedation in Excited DeliriumPSOW
This document discusses a study on the use of ketamine for prehospital sedation of patients experiencing excited delirium. The study aims to determine if ketamine is an effective and safe treatment option that allows emergency responders to control agitated patients and transport them for further care. The document outlines the goals, inclusion/exclusion criteria, procedures, and contact information for the Wisconsin ketamine study being conducted by Drs. Curtis and Cady.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
Wisconsin/Nicaragua Health Projects PartnershipPSOW
This document provides an overview of Partners of the Americas and the Wisconsin/Nicaragua partnership. It discusses how Partners originated from Eisenhower and Kennedy's initiatives to strengthen ties between the US and Latin America. Wisconsin and Nicaragua were paired due to common agricultural economies and geography. The Wisconsin/Nicaragua partnership focuses on community development projects in areas like agriculture, women's programs, health, youth, and humanitarian assistance. A major initiative involves shipping fire trucks and ambulances from Wisconsin to Nicaragua to assist local fire departments. The partnership aims to enhance quality of life through people-to-people exchange programs promoting cultural understanding and sustainable development.
This document discusses the principles of a "just culture" approach in emergency medical services (EMS). A just culture aims to have zero tolerance for reckless behavior while also not blaming individuals for honest mistakes. It references several resources on implementing just culture principles through internal investigations, accountability, leadership, due process, and strategies to create a culture of safety in EMS organizations.
This document discusses the importance of compliance programs for ambulance services. It outlines key federal agencies and regulations related to compliance, including CMS, OIG, ACA, FCA and AKS. The OIG requires ambulance services to implement a seven-element compliance program. Non-compliance can result in fines and penalties. The document urges services to conduct internal audits, ensure documentation like PCRs support medical necessity and billing, and check that billing companies follow proper coding methods. Maintaining a strong compliance program is necessary to avoid issues with regulators and ensure ambulance services are paid appropriately.
This document discusses how a community paramedic program supports the goals of accountable care organizations (ACOs) in achieving the "Triple Aim" of improving patient care, improving population health, and reducing costs. It provides examples of how community paramedics can coordinate care between primary care, hospitals, and other partners to reduce emergency department visits and hospital readmissions. The document also outlines various payment models that reimburse for services like care coordination that community paramedic programs provide.
The document summarizes a CPR challenge between the cities of Wausau and Stevens Point in Wisconsin. It describes how the challenge was organized by Sherrie Galle-Teske to train people in hands-only CPR and deploy more AEDs. Over two months in 2016, the challenge resulted in 3,559 people trained in CPR and 3 new AEDs placed. Wausau trained 2,225 people while Stevens Point trained 1,334. The foundations raised $4,500 total to support new AEDs. The challenge was a success in building community relationships and awareness around CPR training.
This document discusses establishing a culture of safety in emergency medical services. It notes that most medical errors are due to systemic issues, not individual mistakes. A "just culture" is proposed that is not focused on blame but rather shared accountability. Under a just culture, the organization is responsible for safe systems and processes, while employees are responsible for safe behaviors. Errors are categorized as human errors from flawed systems, at-risk behaviors where risks were unrecognized, or reckless behaviors with conscious disregard for risk. Different approaches are recommended for managing each type of issue, focused on system improvements, coaching, or discipline depending on the situation. An overall goal is to establish trust so that employees feel safe providing feedback to further improve safety.
PSOW 2016 - HIPAA Compliance for EMS CommunityPSOW
The document discusses changes to HIPAA regulations and compliance requirements for emergency medical services organizations. Key points include:
- Major changes from HIPAA/HITECH include an expanded definition of business associates, new requirements for business associate agreements and breach notification, and increased civil penalties.
- Non-compliance can result in significant fines from audits by the Office for Civil Rights. Fines have been issued in the millions for violations like unencrypted devices being stolen.
- Third party assistance can help EMS organizations establish HIPAA compliance programs and avoid "willful neglect" violations that carry mandatory minimum fines. Regular risk analysis and security practices are important to maintain compliance.
This document outlines the culture and strategic plan for Austin-Travis County EMS. It discusses their mission to provide reliable and effective emergency medical services that exceed expectations. The strategic plan focuses on four pillars - People, Service, Quality, and Finance. Under each pillar are strategic objectives like attracting and retaining quality employees, delivering high quality patient care, promoting a culture of safety and innovation, and ensuring good financial stewardship. The document emphasizes the importance of leadership and leading with love and respect to inspire employees and achieve exceptional results.
Jerry Miller is the presenter and has over 33 years of experience in EMS and fire. He will discuss ambulance accreditation from CAAS and CAMTS and how it may impact reimbursement. Currently, CAAS does not emphasize accreditation for reimbursement but CAMTS is working with CMS to potentially tie reimbursement to accreditation. Over the next 5 years, accreditation may impact air ambulance reimbursement. MedPAC is studying ambulance reimbursement and larger reform that could include quality issues. Upcoming reimbursement challenges include sequestration cuts, expiration of temporary rate increases, and potential 3.5% loss in Medicare rates.
The document provides an overview of recent and upcoming changes to Wisconsin's EMS system. It discusses new licensing rules, educational standards, exam changes, and strategic initiatives around quality reporting and emergency driving. The organizational structure of the EMS Section is also outlined.
This document describes the use of ketamine to sedate combative patients exhibiting excited delirium syndrome in Wisconsin. It outlines that ketamine is ideal for this purpose as it works rapidly with a single dose, has minimal adverse effects, and supports heart and breathing function. The document then summarizes Wisconsin's experience using ketamine for over 30 patients, finding it effectively controlled agitation in most cases within 5 minutes with few complications. It discusses dosing, demographic trends, and questions around intubation of some patients.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document summarizes the components of an EMS quality management program, including quality assurance, continuous quality improvement, after action reviews, and confidentiality policies. It discusses retrospective case reviews, statistical analysis of performance indicators, and multi-agency reviews of major incidents to improve protocols, education, and standardization.
The document discusses how healthcare reform will impact ambulance services and individuals. It outlines both positive and negative effects. Positively, more people will gain health insurance coverage. However, ambulance services face potential reductions in Medicare reimbursement rates through measures like productivity adjustments. The document provides an overview of major provisions and recommends steps like improving Medicaid rates and compliance to address the changes.
This document provides an overview of managing controlled substances in EMS. It discusses diversion control and why record keeping is necessary to prevent theft and protect public health. Key points include:
- Controlled substances must be securely stored and strict records kept of ordering, inventory, administration and disposal.
- Schedule II drugs like fentanyl require DEA Form 222 to order and have separate record keeping from other schedules.
- Inventories must be taken at least annually and any shortages or evidence of tampering reported immediately.
- Proper training, policies, separation of duties and periodic audits can help ensure compliance and prevent diversion within EMS agencies.
The document outlines the costs associated with outfitting and operating a paramedic ambulance. It states that the total cost to outfit a paramedic unit is $175,400 and includes a Type III ambulance ($123,000), cardiac monitor ($32,000), stretcher ($3,000), stairchair ($2,900), and miscellaneous medical supplies and radios ($10,000 + $4,500). It also notes that it costs $62 per hour to fully staff a paramedic ambulance with one EMT and one paramedic.
This document provides statistics on electricity generation, sales, and infrastructure in Sri Lanka for the years 2014-2015. Key highlights include:
- Total electricity generation increased 5.9% from 12,357 GWh in 2014 to 13,090 GWh in 2015.
- Revenue from billed electricity sales decreased 8.13% from 204,672 million rupees in 2014 to 188,036 million rupees in 2015.
- The number of consumer accounts grew 4.26% from 5,417,532 in 2014 to 5,648,132 in 2015.
The document provides data on outpatient interventional cardiology procedures from January 1, 2009 to December 31, 2009 at Great State University Medical Center and comparison hospitals. It includes information on patient demographics such as age distribution, payer type, race, and gender. It also provides data on the types of cardiology procedures performed at the focus hospital and comparison hospitals, including the top 15 procedures by count. The procedures are categorized into non-invasive, invasive, peripheral vascular, and electrophysiology groups.
Nodal Insights for Generation Owners and Modeling with AURORAxmpEPIS Inc
Managing consultant and power industry veteran, Bill Babcock, presented on "Nodal Insights for Generation Owners" at the 2014 EMFC and discusses why both local and interregional transmission constraints matter. He outlines what constitutes nodal hub prices vs. zonal prices, and discusses the role shift factors, congestion, and marginal losses have on prices. Based on work he has done modeling PJM with AURORAxmp’s Nodal Capability, including its LMP contributions output report, Bill shows how to identify those constraints that drive congestion-based LMP differences. Visit http://epis.com/xmp_in_action/real_examples.php for more real examples of AURORAxmp in action or visit http://epis.com/aurora_xmp/nodal_analysis.php to see more about Nodal Insights.
Bulent Eren presented information on Turkey's health insurance sector. Some key points:
- Turkey has a population of 76 million with a GDP of $820 billion and per capita GDP of $10,700.
- The insurance sector includes 68 companies, with 61 active including 4 life and 18 pension companies.
- Health expenditures have grown significantly from $5 billion in 1999 to $76 billion in 2012, increasing as a percentage of GDP from 4.8% to 5.4% over that period.
- The Turkish health system includes both public and private providers, with financing from social security, private insurance, and out-of-pocket payments.
- Private health insurance premiums have grown substantially
EEB is a leading energy company in Colombia and other Latin American countries. It operates across various areas of the energy sector including electricity transmission and distribution, natural gas transportation and distribution, and electricity generation. EEB has a strong presence in Colombia, Peru, Guatemala and other markets through various subsidiaries. It has ambitious investment plans for the 2013-2017 period to expand its electricity and gas infrastructure. EEB has consistently delivered stable financial results with growing revenues and earnings. It also provides attractive dividends to shareholders.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
13. 2015 INFLATION UPDATE
• On August 29, 2014, CMS issued
Transmittal 3057, which contained the
Ambulance Inflation Factor (AIF) for
CY 2015
AIF = CPI-U – MFP
CPI-U = 2.1%
MFP = 0.7%
AIF = 1.4%
14. TEMPORARYADJUSTMENTS
• On April 2, 2014, the President signed the
Protecting Access to Medicare Act of 2014
• Extension of temporary adjustments through
March 31, 2015
– 2% urban
– 3% rural
– “super rural” bonus
• Does not provide for a suspension of 2%
“sequester”!!!
15. PERMANENT REDUCTION
FOR DIALYSIS SERVICES
• American Taxpayer Relief Act of 2012
mandated a permanent 10% reduction in
Medicare’s payment for BLS non-emergency
ambulance transports to/from dialysis
• Transmittal 2703 (May 10, 2013)
– Reduction will be applied to any claim
submitted:
• A0428
• “G” or “J” modifier as either the origin or destination
16. FUTURE OF DIALYSIS
• Future Congressional Action
– Further reductions to Fee Schedule Payments
• Nothing currently proposed for 2014
– Cap on number of covered ambulance trips
• Per patient per year
• Similar to physical therapy caps
– Possible expansion of dialysis payment bundle
– “Safe harbors” to induce dialysis facilities to transport
their own patients
• Increase in Enforcement Activity
17. PART B PAYMENT
DATA RELEASE
• On April 9, 2014, CMS released the
Medicare Provider Utilization
– Sortable database of FFS payments by individual
physician, ambulance supplier and other health
care suppliers
– http://projects.wsj.com/medicarebilling/?mod=medicarein
– A.A.A. Press Release and Talking Points
• See handouts
20. MEDPAC REPORT
Key Findings:
• In 2011, Medicare paid $5.3 billion for ambulance services
• 3 temporary adjustments for ground ambulanced accounted for
$192 million
• 2 permanent adjustments accounted for $220 million
• 50% increase for rural miles 1 – 17
• 50% increase for rural air ambulance
• Ambulance volume increased by 10% from 2007 to 2011
• Most of increase in volume was from increase in BLS-NE
• Dialysis in particular
• Increase centered in urban areas
• Number of ambulance providers has grown steadily since 2007
21.
22. MEDPAC REPORT
Conclusions:
• Current adjustments for ground ambulance are not
good indicators of transports with relatively high
costs
• i.e., high costs with low volumes
• Medicare beneficiaries are not experiencing access
to care problems
23. MEDPAC REPORT
Recommendations:
• Permit expiration of current temporary
adjustments
• Decrease rate for BLS non-emergencies (5.7%)
• Increase base rates for ALS, ALS-2, SCT and BLS-E (2.8%)
• Restructure existing adjustment for rural ground miles 1 –
17
• Better target isolated, low volume providers
• Implement new national claims processing edits
• Better define medical necessity
requirement
25. OIG REPORT ON UTILIZATION
• Between 2002 – 2011:
– 69% increase in Part B ambulance transports
– 34% increase in number of beneficiaries requiring
ambulance transport
– 26% increase in number of ambulance suppliers
• ~ 100% increase in number of BLS-NE suppliers
– 269% increase in dialysis transports
• 85% increase in number of ESRD patients transported by
ambulance
– 829% increase in transports to partial
hospitalization programs
26. OIG STUDY ON APPEALS
• The First Level of Medicare Appeals Process, 2008
– 2012: Volumes, Outcomes, and Timeliness
• October 2013
• MACs processed 2.9 million redeterminations in
2012
– 33% increase over 2008
– 233,941 appeals for ambulance
• 3% increase over 2008
• 51% of Part B appeals were favorable to providers
– 43% for ambulance claims
27. PROPOSED RULE RE: CMPS
• May 12, 2014 Proposed Rule
• Expands OIG’s authority to impose civil monetary
penalties for certain misconduct
– $15,000 per day for failure to grant timely access
to records in connection with an audit or
investigation
– $10,000 per day for each day an overpayment is
not returned following the 60th day after it has
been “identified”
28. PROPOSED RULE RE:
EXCLUSIONS
• May 9, 2014 Proposed Rule
• Revises OIG’s exclusion authority to incorporate
ACA changes
– Would give OIG right to exclude individuals
convicted for obstructing an audit or investigation
– Expands OIG’s authority to exclude individuals
for failing to supply certain payment data to CMS
– Would give OIG right to exclude individuals that
knowingly make false statements in connection
with the submission of an enrollment application
29. OIG GUIDANCE ON EXCLUSIONS
• On May 8, 2013
• Updated Special Advisory Bulletin on Effect of Exclusion
from Participation in Federal Health Programs
• Reiterates existing guidance on consequences of employing
an excluded individual
– Prohibition would extend to those not involved directly in patient care
• Management and billing
• Driving an ambulance
• Ambulance dispatch services
• Referring physician or individual signing PCS form
30. EXCLUSION TESTING
• Employees
– IG recommends testing employees once a month
• Referring Sources
– Repetitive Patients v. Non-Repetitive Patients
• Vendors
– Contractual commitment to do testing on employees of
vendor that service your accounts
– Indemnity?
31. OIG ADVISORY OPINIONS
• Billing Waivers & Waiver of Coinsurance
– Opinion 13-17 – IG permitted a municipal ambulance service
to use tax revenues to cover out-of-pocket expenses due fro
non-residents
– Opinion 13-14 – IG permitted the waives coinsurance and
deductibles due from residents for EMS provided by a county
EMS agency and several volunteer rescue squads.
– Opinion 13-11 – IG permitted a BLS ambulance supplier to
accept payment from the town for cost-sharing amounts due
from residents. The private ambulance service also agreed to
waive cost-sharing amounts when responding under mutual-aid
– Opinion 13-08 – IG permitted a fire protection district to NOT
bill residents or their insurance
• Expansion of existing line of opinions that permitted taxpayer-supported entities
to bill only to the extent of a resident’s insurance
32. OIG ADVISORY OPINIONS
• Reimbursement for Dispatch
– Opinion 13-05 – IG permitted a municipality to require
the winner of an RFP for 911 services to reimburse the
municipality for a portion of dispatch costs
• County Health District
– Opinion 13-04 – IG permitted a County Health District to
provide non-emergency ambulance services, which would
include the provision of transports to/from County health
facilities
33. OIG ADVISORY OPINIONS
• Opinion 13-18
– RFP asked bidders to provide:
• Free ambulance transports to City employees
• Free AEDs and other equipment
• Free EMS training
• 20% discount on ambulance transports to uninsured seniors
• Replenishment of supplies used by City first-responders
– OIG took issues with the proposal to provide free or
below-market equipment to the City, and therefore refused
to sign off on the arrangement as a whole
35. 2015 PROPOSED RULE
• July 11, 2014
• Technical changes to reflect extensions of temporary
adjustments through March 31, 2015
• 2% Urban
• 3% Rural
• “Super Rural” Bonus
• Proposal to adopt recent OMB modifications to Rural-
Urban Commuting Area (RUCA)
– CMS estimates
• 122 zip codes go from Urban to Rural
• 100 zip codes would go from Rural to Urban
• No impact on super rural
– AAA estimates
• 1,500 zip codes go from Rural to Urban
37. AMBULANCE ‘BACK
BILLING’
• CMS proposing to limit effective date
of Medicare billing privileges to later
of:
–Date enrollment application is filed
–Date you begin providing services at new
practice location
38. REVOCATION OF
BILLING PRIVILEGES
• CMS proposing to expand its authority
to revoke billing privileges for
providers that have engaged in “a
pattern or practice” of abusive billing
– Including high percentage of claim denials
39. LIMIT ON USE OF
CORRECTIVE ACTION PLANS
• CMS proposing to limit the use of Corrective
Action Plans (CAPs) to minor issues of non-compliance
– e.g., failure to timely file revalidation
• CMS indicated that failure to disclose a “Practice
Location” would not be eligible for CAP
– Would require you to appeal
40. PATIENT SIGNATURE
REQUIREMENT
• July 11, 2014
• Transmittal 2984
• CMS removed the requirement that you must
capture the address of anyone signing on the
patient’s behalf
• The AAA had requested this change over 2
years ago
41. SNF RECOUPMENTS
• In 2013, CMS issued a transmittal
instructing RACs to recoup ambulance
transports between two SNFs
– Indicated by use of Discharge Status Code
“03” on the SNFs claim
–Effective April 7, 2014
42. ICD-10 CODES
• Implementation delay until October 1,
2015
• ICD-9 Codes: ~ 17,000
• ICD-10 Codes: ~ 150,000
If you want to laugh:
http://www.youtube.com/user/findacode
43. ICD-10 CODES
• AAA has published an ICD-10
crosswalk for the current CMS
Medicare Condition Code List
• See handout
44. MEDICARE REVALIDATION
• CMS is continuing its efforts to require all existing Medicare
providers and suppliers to “revalidate” their Medicare
enrollment information
– Original target date: March 2013
– Extension: March 2015
–2014 Enrollment Fee: $542
• Medicare contractors given discretion on when to revalidate
various provider groups
• Failure to revalidate can result in 1 year ban on participation
in Medicare!!
45. MEDICARE REVALIDATION
• List of all providers that have been asked to
revalidate, arranged by calendar quarter
• CMS Website:
– http://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/MedicareProviderSupEnroll/Revalidationshtml
46. ALJ DELAYS
• November 2013 – Office of Medicare
Hearings and Appeals (OMHA) announces
substantial delay in assignment of new cases
to ALS
– 24 months for new case assignments
– 6+ months for hearings to be held
– Up to 3 years before a decision should be
expected!!
47. ALJ PILOT PROJECT –
SETTLEMENT CONFERENCES
• On July 7, 2014, OMHA announced a new
mediation program designed to reduce the ALJ
backlog
– Settlement Conference Facilitation (SCF)
• Eligibility requirements
– 20 or more claims at issue
– $100,000 or less at issue
– Beneficiary must not have been determined to be
liable for
48. ALJ PILOT PROJECT –
STATISTICAL SAMPLING
• Project for appeals involving large numbers of
claims
• ALJ will review a sample of appealed claims,
and extrapolate against larger universe of
appealed claims
• Eligibility requirements
– 250 or more claims at issue
– No request for Settlement Conference
– Beneficiary must not have been determined to be
liable for
49. MEDICARE ADVANTAGE
PLANS
• CMS announced that it is suspending the
“Payment Dispute Resolution Process”
as of February 1, 2014
– Used to resolve situations where MA plan
pays the claim, but at the incorrect rate
– Lack of funding
50. A.A.A. MEDICAID
RATE SURVEY
• In March 2014, the A.A.A. completed a
survey of the current Medicaid rates in
all 50 states
– Includes information the payment of Medicare
crossovers
– See handout
51. V.A. MILLENNIUM BILL
• V.A.’s payment for emergency
ambulance services is contingent on V.A.
paying for veteran’s care at hospital ED
– Patient’s with Part A Medicare, but not Part
B
– Must bill veteran
52. AIR AMBULANCE
• On April 21, 2014, the FAA announced
delay in implementation of new
helicopter ambulance safety standards
– Impacts certain operating rules
– New compliance date is April 22, 2015
– Does not impact new requirements for terrain
awareness and warning systems or flight data
monitoring systems
• April 22, 2017/2018 implementation dates
55. The Scope of the Problem
• CMS estimated that Medicare lost
more than $24 billion on fraud and
abuse in FY 2009
– Roughly 7.5% of total payments
• Other experts place the number at as
high as $70 billion per year!!
56. Funding for
Anti-Fraud Measures
• ACA allocated an additional $250 million to
fund additional audits
• New provisions that allow Medicare
contractors to use recoupments to fund
further anti-fraud activities
– Allow process to become self-sustaining!!
57. • Away:
Shift in Focus
– Random post-payment audits
– So-called “Pay and Chase”
• Towards:
– Use of data analysis to identify systemic
issues
– Use of prepayment reviews
58. EMS Areas of Focus
1. ALS emergency
transports
2. Hospital Discharges
3. Dialysis
59. The City of Dallas
• Investigation into overutilization of ALS
emergency
– $2.5 million settlement
– Debate as to whether overbilling was fault of City or its
billing agent
• 12 neighboring cities paid $1.2 million to settle
similar charges
– Same billing agent
60. •September 2008, a whistleblower suit is
filed alleging town was overbilling ALS
emergency
–95% of transports billed ALS emergency
•Town settles for $4.5 million
–Based on advice of lawyers, who indicated
potential liability could reach $100+ million
•Town sues lawyers for malpractice
–They allege actual overpayment was only
$108,000
Clinton, Iowa
61. NORIDIAN HEALTHCARE
SOLUTIONS
• July 30, 2014 letter to provide community
• Purportedly to educate on common errors
• Issues:
1. PCS Form – “simply checking boxes or
listing medical conditions/diagnosis is
inappropriate”
2. SCT – “Critical illness/injury is defined
as….a patient who is experiencing an acute
life-threatening episode”
62. NORIDIAN HEALTHCARE
SOLUTIONS
•Targeted prepayment reviews
throughout its service areas
•California
•Utah
•Northern Marianas Islands
63. OIG REPORT ON UTILIZATION
• Between 2002 – 2011:
– 269% increase in dialysis
transports
• 85% increase in number of ESRD patients
transported by ambulance
65. Case Study: Texas Dialysis
“In 2007, Medicare paid $38 million per
year to Texas ambulance suppliers related to
excess services per beneficiary, compared to
services per beneficiary in the remainder of
the U.S. Audit findings…show that much
of the excess is not justifiable based on
the patients’ conditions.”
70. Case Study: Puerto Rico
“FCSO quickly identified an extreme data anomaly
related to non-emergency ambulance services
provided in Puerto Rico and the U.S. Virgin
Islands. More specifically, our analysis of paid
claims data for procedure code A0428 – ambulance
service, basic life support, non-emergency
transport (BLS), revealed that utilization in Puerto
Rico for this procedure code was over 1,000
percent higher than the rest of the United
States.”
71. Case Study: Puerto Rico
“Data analysis also revealed that 95 percent of
non-emergency ambulance utilization in
Puerto Rico involved repetitive transportation of
dialysis patients to/from their dialysis facilities
as compared to less than 5 percent in Florida.
Although dialysis patients may have multiple
health issues, the vast majority can safely and
routinely travel by means other than an
ambulance.”
72. Putting That In Perspective…
• 2008 Medicare Payment Data:
– Puerto Rico
• ~620,000 Medicare beneficiaries
• 407,000 dialysis transports
– CA, FL and NY combined
• ~11 million Medicare beneficiaries
• 356,000 dialysis transports
74. The City of Brotherly
Love
• Medicare Strike Team has been actively
investigating ambulance services
― Focus on dialysis
― Numerous indictments
― Sept. 27, 2013 – Philly couple charged with $4.4
million fraud involving medically unnecessary
services and payment of kickbacks
― April 23, 2013 – 7 individual charged with
conspiracy to commit $3.6 million health care
fraud
75. Recent Fraud Convictions
• Texas – owners of a Rio Valley ambulance service and a
billing agency indicted for submitting approximately 1,500
false claims for dialysis patients
• Texas – owner of a Houston-based ambulance service
convicted of $2.4 million fraud involving false claims for
dialysis
• Los Angeles – owners of LA ambulance service plead
guilty to $13 million fraud involving dialysis patients
• Indiana – general manager of a ambulance service pleads
guilty to complex fraud involving falsified trip reports for
dialysis transports
76. Harris County, Texas
•Rep. Kevin Brady (R – TX 8th) has called for
hearings on Medicare ambulance fraud in
Houston
– Fallout from Houston Chronicle articles
•2009 Medicare Payment Data
– $62 million spent on ambulance in Houston
– $7 million spent on ambulance in NYC
77. Harris County, Texas
•Sen. Orrin Hatch (R – UT)
•Sen. Charles Grassley (R – IA)
•February 2, 2012 letter to HHS Secretary
Sebelius
– Asking for steps CMS is taking to curb ambulance
abuses in Houston
– Focus on dialysis
– Asking specifically why CMS has not imposed a
temporary moratorium on new enrollments
78. TEMPORARYMORATORIUM ON
NEW ENROLLMENTS
• On July 26, 2012, CMS announced a temporary
moratorium on enrollment of new ground ambulance
suppliers in Houston and surrounding counties
• Response to wide-spread fraud and abuse
• Key findings:
– 26 counties in US with more than 200,000 Medicare beneficiaries
• On average, there is less than 1 ambulance supplier for every 10,000
Medicare beneficiaries in these counties
• 9.5 ambulance supplier per 10,000 Medicare beneficiaries in Harris
County, Texas (Houston)
• 275 active ambulance suppliers in Harris County
– Two-thirds have not been billing continuously since 2008
79. TEMPORARYMORATORIUM ON
NEW ENROLLMENTS
• On February 4, 2014, CMS announced that it was
extending the moratorium on new ambulance
enrollments in Houston metropolitan area for
another 6 months
– Through June 30, 2014
• New temporary moratorium on enrollment of new
ambulance suppliers for Philadelphia
metropolitan area
• Further extended through December 31, 2014
80. PRIOR AUTHORIZATION
DEMONSTRATION PROJECT
• On May 22, 2014, CMS announced that it was
implementing a prior authorization process for
dialysis transports in 3 states
– New Jersey
– Pennsylvania
– South Carolina
• Prior authorization required for claims to be
paid
– Alternative is 100% prepayment review
81. PROTECTING INTEGRITY IN
MEDICARE ACT OF 2014
• Proposes to expand dialysis prior
authorization project nationwide
– 2015
• MAC Jurisdiction L (DC, DE, MD)
• MAC Jurisdiction 11 (NC, VA, WV)
– 2017
• Rest of the nation
82.
83. Brian Werfel, Esq.
A.A.A. Medicare Consultant
631-265-5650
bwerfel@aol.com