LUTZ BUSINESS INSIGHTS
cah ambulance changes
claire thelen, senior healthcare consultant
The current policy for ambulance services furnished by a CAH or an entity that is owned and operated by a CAH is 101 percent of the reasonable costs of the CAH or the entity in furnishing those services, but only if the CAH or the entity is the only provider or supplier of ambulance services located within 35-miles of the CAH. To ensure that areas served by CAHs have adequate access to ambulance services, the DHHS is proposing to revise the current policy.
What is changing? Effective for cost reporting periods beginning on or after October 1, 2019, CMS is revising its interpretation to exclude consideration of ambulance providers or suppliers that may be within that 35-mile range but are not legally authorized to furnish ambulance services to transport individuals to or from the CAH.
Why the change? If a CAH does not receive reasonable cost-based payments for its ambulance services because there is another provider or supplier of ambulance services within a 35-mile drive of the CAH, even if that provider or supplier is not legally authorized to transport individuals either to or from the CAH, the CAH may be unable to support the costs of providing ambulance services in its service area. DHHS is proposing to address this “gap” in the current regulation.
Consistent with the existing policy, if there is no provider or supplier of ambulance services located within 35 miles of a CAH and there is an entity that is owned or operated by a CAH that is more than 35 miles from the CAH, payment for ambulance services furnished by that entity is 101 percent of the reasonable costs of the entity furnishing those services, but only if the entity is the closest provider or supplier of ambulance services to the CAH.
ABOUT THE AUTHOR
CLAIRE THELEN + SENIOR HEALTHCARE CONSULTANT
Claire Thelen is a Senior Healthcare Consultant at Lutz with over four years of experience in the healthcare industry. She provides chargemaster, billing and coding and revenue cycle consulting services to clients with a focus on hospitals and healthcare systems.
AREAS OF FOCUS
- Healthcare Consulting
- Hospitals & Healthcare Systems
- BS in Health Care Administration, University of Nebraska, Omaha, NE
- Concentration in Nursing, Clarkson College, Omaha, NE
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