Preparing for Dialysis Transport Payment Reductions

Last Week
In our last blog we provided information regarding the announced 10% payment reduction that is being put in place by the Center for Medicare and Medicaid Services (CMS) on all BLS Non-Emergency transports to and from dialysis treatments for patients diagnosed with End Stage Renal Disease (ESRD).

Effective October 1, 2013
Now that you understand what’s coming, we’ll help suggest how you can prepare for this change. The change takes place on October 1, 2013, so between now and then there are definitely things that you can do.

Revisit the Budget
First, it’s time to take a look at your budget. What ambulance service can afford to take a 10% hit on any of its revenue streams, today? Your service is probably in the same boat as any other service, but waiting until October to make adjustments is going to put you in a bind if you’re unprepared. It’s time, right now, to consider staffing adjustments, put off equipment purchases or delay any new costly initiatives.

Run Reports
Run your reports. Ask your billing office to help you determine what the potential hit is going to be. We hope that you work with a billing outsourcer (like Enhanced) that provides you with the tools to easily assess what the damage will be or you have access, in-house, via your billing office to information that can carve out these transports from your billing system data.

You have to know the numbers before you can devise a plan to offset the revenue loss.

Lock your key people in a room for a few hours and think about what your company can do to develop alternative revenue streams. In that same think-tank session, consider how you might be able to shift transportation of the affected ESRD patient population to other modes of transportation that may be less costly.

Medical Necessity?
It’s time to ask the question; “Which dialysis patients truly need ambulance transportation?”

Frankly, this is a question that should have been asked the first day you took the call and added the patient to your dispatch log. The key to Medicare transports is medical necessity! CMS is painfully enforcing this issue, thus the reduction. Congress felt it had to take action and did so based on its studies and findings.

Whether we agree or not, the Federal Government is convinced that most ESRD patients do not require ambulance transportation to and from the dialysis facility. They are citing their own analysis and studies and have indicated that this type of transport is costing the Medicare program millions of dollars and the level of usage has increased rapidly. In an effort to curb the rising costs of the Medicare program, this area is one of the big target projects in a concerted effort to discourage additional suppliers and providers from joining the ranks.

In order to make the case, ambulance suppliers and providers will need to prove, via appeal, the necessity of the trip for full payment and will be increasingly called upon via the audit process to justify those claims which are paid, even at the reduced rate.

Enhanced is Prepared
Enhanced Management Services is uniquely prepared to offer advice and provide tools for our clients to analyze their data. We’ve put together features like our Enhanced PulsePoint™ Client Portal and Enhanced PulsePoint™ Mobile to benefit our clients by giving them the ability to run reports for review of the numbers for these dialysis transports.

Our Certified Ambulance Coder trained staff also has the know-how to provide the answers to client questions surrounding this issue. If you feel like you’re alone, then maybe it’s time to contact Enhanced for a review of the benefits of working with us for your billing needs.

Business Development Manager, Chuck Humphrey, is waiting for you to contact him. E-mail him today at or give him a call at (800) 369-7544, Extension 108 today.

Current Enhanced clients can feel free to reach out to your Client Services Representative for assistance or consult your Enhanced PulsePoint™ generated information for details.

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