Healthcare Finance: CMS expanding ambulance program integrity payment model nationally

“The Centers for Medicare and Medicaid Services announced Tuesday that 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 agency said.”

“Citing an approach geared to protect taxpayer dollars and target the most significant program integrity risks facing healthcare programs, CMS said it is working to prevent, rather than chase, fraud, waste and abuse through proactive measures. Ambulance services have long been associated with inappropriate overuse and high improper payments, meaning many payments don’t meet program requirements – intentionally or otherwise – and contribute to what the agency called the ‘inappropriate spending’ of Americans’ tax dollars.”

“The CMS Comprehensive Error Rate Testing program, which measures improper payments in the Medicare fee-for-service program, has consistently found ambulance services, specifically non-emergent ambulance transports, to be in the top 20 Part B services with improper payments. The estimated improper payment rates for non-emergent ambulance transports in 2017 and 2018 were 22.6% and 18.6%, respectively…” Read the full article here.

Source: CMS expanding ambulance program integrity payment model nationally – By Jeff Lagasse, September 23, 2020. Healthcare Finance.

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