Читать книгу Emergency Medical Services - Группа авторов - Страница 41

Complaints about Medicare reimbursement for ambulance services based primarily on transportation of the patient increasingly became an issue during the 1990s. Specifically, there were concerns about the lack of uniformity in reimbursement from region to region. The Balanced Budget Act of 1997 required the Health Care Financing Administration (HCFA) to commence a negotiated rule‐making process with industry groups and develop a national fee schedule for ambulance services. That process began in 1999 when HCFA established a rules committee that included HCFA, the American Ambulance Association, the International Association of Fire Chiefs, the International Association of Firefighters, the National Volunteer Fire Council, the AHA, the National Association of Counties, NASEMSO, the Association of Air Medical Services, and a single physician representing both ACEP and NAEMSP.

The regulations and national fee schedule that resulted from the negotiated rule‐making process became effective on April 1, 2002 [69]. The fee schedule established seven national categories of reimbursement for ground ambulances: BLS (emergency and non‐emergency), ALS (emergency and non‐emergency), a second level of ALS for complex cases, paramedic ALS intercept, and specialty care transport. In addition, there were two categories for air medical transport: fixed‐wing and rotor‐wing. The final rule also included adjustments for regional wage differences as well as for services provided in rural areas where the cost per transport is generally higher due to the lower overall numbers of transports. Reimbursement, however, was still generally based on the need for transportation of the patient.

A medical committee was established during the negotiated rule‐making process to develop a coding system for ambulance billing that would better convey to HCFA the medical necessity for transport and the need for ALS. This document was not an official component of the rule‐making process. However, the coding system was eventually adopted in 2005 by the Centers for Medicare and Medicaid Services as an “educational tool.” It was never made a requirement for reimbursement as was originally proposed [70].