Ambulance Transport Waiver – Cost-Sharing Obligations Updates - PowerPoint PPT Presentation

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Ambulance Transport Waiver – Cost-Sharing Obligations Updates

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Generally, an ambulance provider waiving beneficiary cost-sharing obligations implicates the AKS and the beneficiary inducement CMP. – PowerPoint PPT presentation

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Title: Ambulance Transport Waiver – Cost-Sharing Obligations Updates


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(No Transcript)
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Ambulance Transport Waiver Cost-Sharing
Obligations Updates
The Office of Inspector General (OIG) recognizes
that, in the present public health emergency
resultant from the outbreak of the COVID-19, the
health care industry must focus on delivering
required treatment to patients. OIGs Part in
Cost-Sharing Obligations As part of OIGs
mission to encourage economy, efficiency, and
effectiveness in HHS programs, CMS is committed
to protecting patients by confirming that health
care providers have the regulatory flexibility
required to appropriately answer to COVID-19. As
a result, OIG is accepting inquiries from the
health care community about the appliance of
OIGs administrative enforcement authorities,
including the Federal AKS and civil monetary
penalty (CMP) provision prohibiting inducements
to beneficiaries. Do you have a question
regarding how OIG would view a preparation that
is directly linked to the public health emergency
and implicates these authorities, you can now
email your question to OIG Compliance. While you
submit your questions, please provide sufficient
facts to permit for an understanding of the key
parties and terms of the arrangement in dispute.
OIG answers are openly available through
frequently asked questions (FAQ) posting on the
OIG COVID-19 portal.
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Ambulance Transport Waiver Cost-Sharing
Obligations Updates
Cost-Sharing Obligations Waiver FAQ What are the
consequences, under OIGs administrative sanction
authorities, of an ambulance provider or supplier
waiving or write off beneficiary cost-sharing
obligations resulting from ground ambulance
services paid for by the Medicare program under a
waiver established pursuant to section 1135 (b)
(9) of the Social Security Act? OIG responded
that the ambulance provider or supplier waiving
or write off beneficiary cost-sharing obligations
resulting from ground ambulance services paid for
by the Medicare program under a waiver
established pursuant to section 1135 (b) (9) of
the Social Security Act would implicate the
Federal anti-kickback statute and Beneficiary
Inducements CMP. Generally, an ambulance provider
waiving beneficiary cost-sharing obligations
implicates the AKS and the beneficiary inducement
CMP. According to Ambulance Fee Schedule, 80 of
the approved amount paid by Medicare Part B, and
for the remaining 20 as well as the applicable
Part B deductible the beneficiary is responsible.
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Ambulance Transport Waiver Cost-Sharing
Obligations Updates
The government is interested to know that
providers waving the co-payment amount will be
incentivized from the provider so that patients
can receive further covered services. OIG
believes that such co-payments waivers and
incentives have a sufficiently low risk of fraud
and abuse. OIG will not need ground ambulance
providers to accumulate beneficiary cost-sharing
before they claim Medicare bills for such
services. Currently, each state, local and
municipal authorities established communitywide
EMS protocols requiring or allowing ambulance
providers and suppliers to treat certain
patients, including Medicare beneficiaries, in
place who otherwise, but for the pandemic, would
have been transported to a Medicare-covered
destination. Routine waivers of cost-sharing
obligations implicate the Federal anti-kickback
statute and therefore the civil monetary penalty
provision prohibiting inducements to
beneficiaries and should end in overutilization
or inappropriate utilization of things and
services reimbursable by Federal health care
programs. In light of those EMS protocols, on
May 5, 2021, pursuant to section 1135(b)(9) of
the Social Security Act, the Secretary of Health
and Human Services waived certain
statutory requirements concerning to Medicare
payments for ground ambulance services furnished
in response to a 911 call. Generally, Medicare
billing requires such type of transportation
before a ground ambulance provider can get
Medicare reimbursement.
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Ambulance Transport Waiver Cost-Sharing
Obligations Updates
According to HHS, the FAQ is a complimentary
answer related to ambulance providers and
suppliers waiving or write off beneficiary
cost-sharing obligations causing from ground
ambulance services reimbursed for under the CMS
waiver that waives certain statutory necessities
relating to Medicare payment for ground ambulance
services.   To know more about Ambulance
Transportation billing services, contact us
at info_at_medicalbillersandcoders.com / 888-357-3226
.
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