CMS to expand prior authorization for ambulance transport

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, CMS to expand prior authorization for ambulance transport

CMS will develop its prior authorization mannequin for non-emergency ambulance transport nationwide, the company mentioned Tuesday.

The mannequin, which allowed Medicare to pay ambulances for taking sufferers to scheduled non-emergency healthcare visits, saved the federal authorities about $650 million over 4 years, CMS mentioned in an announcement. The experiment did not seem to trigger critical opposed outcomes, analysts mentioned within the company’s second interim analysis report of the mannequin. CMS mentioned it is monitoring the COVID-19 pandemic to find out when it is smart to roll out the mannequin to new states.

“Ambulance companies have lengthy been related to inappropriate overuse and excessive improper funds, which means many funds do not meet program necessities — intentional or in any other case — and contribute to inappropriate spending of People’ tax dollars,” the company mentioned in an announcement.

The estimated improper fee fee for non-emergency ambulance transports was 22.6% in 2017 and 18.6% in 2018.

General, CMS mentioned the mannequin lowered the scheduled transports by 63% and associated bills by 72% for Medicare beneficiaries with end-stage renal illness or extreme stress ulcers.

All of the mannequin’s present contributors will proceed to take part within the mannequin previous the pilot’s unique finish date of December 1. They embrace Delaware, Maryland, New Jersey, Pennsylvania, North Carolina, South Carolina, Virginia, West Virginia and Washington, D.C.

Based on the report, analysts discovered the mannequin led to a small lower in dialysis use and a slight enhance in emergency dialysis use amongst ESRD beneficiaries. Researchers additionally noticed a discount in emergency division use and unplanned hospitalization with no impression on mortality.

“Ambulance suppliers that depended closely on (repetitive, scheduled, non-emergent ambulance transport) exited the market when the mannequin began, significantly in 12 months one states,” the report mentioned.


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