The NC EMS Administrators Reimbursement Committee met with representatives from Division of Medical Assistance (DMA) to discuss the progress of the outstanding issues related to Ambulance Reimbursement.

New Ambulance Policy to include reimbursement for in-county miles

The policy staff of DMA has developed a new Ambulance Policy that will be presented to the Physicians Advisory Group (PAG) for review and recommendation.  The policy will incorporate all of the recent publications where changes have taken place into one concise Ambulance Manual. The new policy will contain payment for all loaded patient miles. 

It is expected that the PAG will review the Ambulance Policy during their next meeting on October 28 or at the November meeting.  They will make recommendations to the policy staff of DMA.  The policy will be published on the DMA website for a 45 day comment period.  The ambulance providers will have the opportunity to provide feedback during this time.  The policy will become effective after the comment period has expired.

DMA suggested that a January or February 2005 effective date would be realistic. 

Medicare Crossovers

Medicare crossovers were reinstituted for dates of service September 06, 2004 and after.  These claims will automatically crossover from Medicare.   Medicaid will pay 75% of the coinsurance and/or deductible amounts after the Medicare payment has been made.   One important note is that these crossovers only apply to claims submitted to Medicare Part B.  These crossovers do not apply to claims submitted to Medicare Part A on the UB-92 claim form. 

Medicaid Rate Increase
Comments were made to DMA regarding the process to implement an overall fee increase for Medicaid ambulance transportation.  Since it is understood that the process could be a lengthy one, the committee would like to begin the process as soon as possible.  The first step would be to conduct a statewide cost analysis related to the actual cost to provide ambulance services, both in a rural and urban setting, as well as from a private and public perspective. 

The Reimbursement Committee will continue to keep the members informed of the progress of the Medicaid Ambulance Policy.