Rural Ambulances: Medicare Fee Schedule Payments Could Be Better Targeted
HEHS-00-115
Published: Jul 17, 2000. Publicly Released: Aug 03, 2000.
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Highlights
Pursuant to a congressional request, GAO reviewed Medicare payments for ambulance services in rural areas, focusing on: (1) the challenges faced by rural ambulance providers; (2) how the upcoming fee schedule will affect rural providers relative to their current situation; and (3) what factors have affected claim denial rates for ambulance services.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Administrator, Health Care Financing Administration, should develop a more refined payment adjuster that better targets the ambulance providers that serve isolated, rural areas where their services are essential to ensuring that Medicare beneficiaries have access to ambulance transports. The rural adjuster should also be structured toward providers' high fixed costs incurred because of the low volume of transports in these isolated areas. |
CMS agreed that a more refined payment adjuster than the one agreed upon during negotiated rulemaking was needed for ambulance providers that serve isolated rural areas. CMS agreed to work with the ambulance industry after the final rule was published, to identify and collect relevant data to refine the adjustments. The agency issued a final rule on the ambulance fee schedule on February 27, 2002, with an implementation date of April 1, 2002. The rural payment adjuster in the final rule was the one GAO and CMS agreed needed to be further refined. However, responding to concerns about Medicare payment rates for rural ambulance trips, in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the Congress increased the base Medicare payment for ambulance trips that originate in qualified rural areas. This fulfilled the intent of GAO's recommendation.
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Claims processingEconomically depressed areasEmergency medical servicesHealth insuranceHealth resources utilizationMedical feesMedical services ratesMedicareTransportation policiesFederal rulemaking