The Centers for Medicare & Medicaid Services Fee Schedule for ambulance services determines the rates and structure CMS reimburses EMS agencies. Since Medicare and Medicaid are substantial payers for agencies within Texas , the Medicare Fee Schedule immensely impacts EMS billing and financial planning.
Medicare reimburses ambulance services based on the lower of two amounts: the actual charge or the fee schedule rate. This second one combines a base rate for the level of service plus mileage and specific adjustment factors. Payments are assignment-related from contractual allowances, meaning EMS providers must accept Medicare’s allowed charge as full payment. Besides, providers can bill beneficiaries for their unmet Part B deductible and coinsurance amounts.
Key Components of Medicare Fee Schedule
Service Level Base Rates and RVUs: Medicare determines the base rate by multiplying the Conversion Factor (CF) with the Relative Value Units (RVUs) for each service level. Both urban and rural areas receive specific adjustments. For services furnished between July 1, 2008, and December 31, 2024, urban areas will receive a 2% rate increase, while rural services get a 3% increase.
Geographic and Rural Adjustments: The Geographic Adjustment Factor (GAF) modifies 70% of the base rate for ground ambulance services. For rural pickups, the Rural Adjustment Factor (RAF) boosts the mileage rate by 50% for the initial 17 miles and then applies the standard rate after that. Ensuring the correct point-of-pickup ZIP code on claims is crucial for accurate GAF and RAF applications.
Loaded Mileage: Medicare reimburses based on “loaded” miles, distinguishing rates for fixed-wing (FW), rotary-wing (RW), and ground services. Mileage adjustments depend on pickup locations, ensuring fair compensation for mileage based on service demands.
Annual Inflation Updates: Each year, Medicare updates the Conversion Factor (CF), base rates, and mileage rates to align with inflation. These yearly adjustments aim to support EMS providers in covering the rising operational costs.
Partner with EMERGICON for Your Medicare Billing
EMERGICON helps EMS providers navigate the complexities of Medicare’s billing and reimbursement guidelines. Our team stays up-to-date on policy changes, empowering EMS agencies to ensure compliance and optimize revenue management. We handle the complexities that ensure compliance and maximum reimbursement within the guidelines, so EMS providers focus on serving their communities.
If you have questions regarding the Medicare fee schedule for ambulances, contact EMERGICON via our EMS & Client Hotline: 866-839-3671 | support@emergicon.com.
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