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Medicare Expands Provider Enrollment Crackdown

July 29, 2016
FROM:     Page, Wolfberg & Wirth, LLC (www.pwwemslaw.com)
RE:         First responder fundraising efforts bill approved by Senate

On Friday July 29, the Centers for Medicare and Medicaid Services (CMS) announced a significant change to the Part-B ground ambulance moratoria in the Houston and Philadelphia areas. 

Effective July 29, 2016 CMS is: 

• Lifting all moratoria in all geographic locations for Part B emergency ground ambulance suppliers; and
• Implementing new statewide moratoria on all newly enrolling Part-B non-emergency ground ambulance suppliers in Texas, New Jersey and Pennsylvania. 

What Does That Mean?

It all depends on the type of services that the newly enrolling ambulance supplier is going to provide.  As of July 29, 2016: 

• Part B ground ambulance suppliers that plan to provide emergency services may enroll anywhere, including the Philadelphia and Houston areas.

• Part B ground ambulance suppliers that plan to provide non-emergency services are banned from enrolling in Medicare, Medicaid and CHIP if they have a practice location in anywhere in Texas, New Jersey, or Pennsylvania.    

How is CMS Making the Distinction Between Emergency and Non-Emergency Suppliers?

CMS does not state in the Notice how it will identify emergency and non-emergency ground ambulance suppliers for purposes of the new moratoria. There is a checkbox on the CMS 855B application in ATTACHMENT 1, Section D. where the applicant may check what type of runs each vehicle provides. It is possible that any newly enrolling suppliers in PA, TX and NJ who check "Non-emergency runs" on the 855B will be automatically denied enrollment. But, the next question becomes: What will CMS do if a provider does not check the "Non-emergency runs" box, and instead only checks the "Emergency runs" box, and then that supplier subsequently provides and wants to bill for a non-emergency service because it does not meet Medicare's criteria for an emergency transport?  Stay tuned. 

Quick Background

A moratorium on new Part B ambulance suppliers has been in effect in the Houston area since July 31, 2013, and in Philadelphia since February 4, 2014 (see table below). This included all Part B ground ambulance suppliers and the moratoria did not make a distinction between emergency and non-emergency suppliers.

                  Table 2 - Ground Ambulance Moratoria

StateCity/Metropolitan AreaCounties
PA/NJPhiladelphia

Bucks
Burlington (NJ)
Camden (NJ)
Delaware
Gloucester (NJ)
Montgomery
Philadelphia

TXHouston

Brazoria
Chambers
Fort Bend
Galveston
Harris
Liberty
Montgomery
Waller

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