CMS Will Pay Bills for Undocumented Aliens - As part of the Medicare Prescription Drug, Improvement and Modernization Act, on May 9, 2005, CMS issued a final guidance for a system that will allow for payment of medical services rendered to individuals who are not U.S. citizens and are not legally residing in the U.S....

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Restocking after the Fee Schedule - In the mid to late 1990’s ambulance “restocking” was a common practice. An ambulance arriving at an emergency room would often be “restocked” with the items used in treating the patient during transit. The hospital would give these items, such as gloves and medications, to the ambulance at no charge.....

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02-15: Ambulance Service Related Advisory Opinion Released - In an advisory opinion, number 02-15, the Office of Inspector General (“OIG”) has concluded that it would not impose penalties against a municipally owned ambulance service for routine waiver of Medicare co-payments or deductibles. The OIG is the office of the federal government that, among other duties, serves as the watch dog for violations of the Anti Kick-Back Act...

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03-11: Ambulance Service Related Advisory Opinion Released - In an advisory opinion, number 03-11, the Office of Inspector General (“OIG”) has concluded that it would not impose penalties against an ambulance service for__________. The OIG is the office of the federal government that, among other duties, serves as the watch dog for violations of the Anti Kick-Back Act. The advisory opinion was requested by...

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03-111: Ambulance Service Related Advisory Opinion Released - In an Advisory Opinion, number 03-11, the Office of Inspector General (“OIG”) has concluded that it would not impose sanctions against a non-profit, emergency ambulance service for accepting subscription payments in lieu of Medicare Part B cost sharing (co-payment) amounts. The OIG is the office designated by the Department of Health and Human Services (“DHHS”) to serve as the watch-dog for violations of Federal law by healthcare providers. ....

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04-10: Ambulance Service Related Advisory Opinion Released - In a new advisory opinion, number 04-10, issued on August 4, 2004, the Department of Health and Human Service’s (“DHHS”) Office of Inspector General (“OIG”) has concluded that it would not impose penalties against a County or its related entities for an arrangement between first responders and secondary transporters ...

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04-12.13: Ambulance Service Related Advisory Opinions On Waiver of Co-Insurance by Municipalities - In a pair of related Advisory Opinions, numbers 04-12 and 04-13, the Office of Inspector General (“OIG”) has concluded that it would not impose penalties against municipalities for two separate, but very similar, arrangements to waive co-insurance payments (i.e. “insurance-only billing”) ...

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05-07: Ambulance Service Related Advisory Opinion Released - In a new advisory opinion, number 05-07, released on February 25, 2005, the Department of Health and Human Service’s (“DHHS”) Office of Inspector General (“OIG”) has concluded that it would not impose penalties against a City for an arrangement between the City and a private ambulance service who won a competitive bid for the Cities emergent ambulance transports ...

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Distinguishing Consent to Treat from Notice of HIPAA Privacy Policy - In our November 2003 and January 2004 issues, we ran a pair of related articles by Denise Graham, entitled Strategic Documentation: A Key for Survival in the HIPAA Era and When They Just Say No: Documenting Patient Refusals in the Era of HIPAA, respectively.

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EMTALA Revised - The EMTALA (Emergency Medical Treatment and Active Labor Act) rule has recently been revised by CMS. On September 9, 2003, CMS published the revised final regulations in the Federal Register, but the new regs do not go into effect until November 10, 2003 ...

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False Claims Act Applies to Local Governments - In a unanimous decision, the Supreme Court of the United States has ruled that municipalities and county governments are “persons” for purposes of the False Claims Act (“FCA”)...

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Getting Medical Documentation In the Age of HIPAA - Several ambulance services from different states have recently approached me with the same problem: their local hospital refuses to release its patient’s medical records to the service. Why? Because of a fundamental misunderstanding of what the HIPAA Privacy Rule requires....

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Medicare Overpayments Can Go From Bad to Worse - There are many ways in which an ambulance service provider may not get paid by Medicare. A claim may be denied from the beginning, for various reasons. Or, your claim may be paid initially, only to be determined later to be an “overpayment” ...

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New Medicare Appeals Rules - Recently, there was an announcement of a drastic change in the way all medical service providers will appeal denied Medicare claims. On March 8, 2005, the Department of Health and Human Services (DHHS) and the Center for Medicare and Medicaid Services (CMS) published an Interim Final Rule in the Federal Register regarding the Medicare Program entitled “Changes to the Medicare Claims Appeal Procedures”...

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New Nursing Home Rule Requires Written Agreements for Ambulance Services and Payments - Certain ambulance trips must be paid by nursing homes instead of Medicare Part B. Effective October 4, 2004, agreements between nursing homes and ambulance services regarding these trips must be in writing. As part of the Balanced Budget Act, Skilled Nursing Facilities (“SNFs”) began in 1999 to get payments under a prospective payment system (“PPS”). ...

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