HomeMy WebLinkAboutR-2002-039 RESOLUTION NO. 2002-039
A RESOLUTION OF THE CITY OF DANIA BEACH, FLORIDA, SETTING FEES FOR
THE TRANSPORT OF PATIENTS TO"LOCAL HOSPITALS BY THE CITY OF DANIA
BEACH FIRE-RESCUE DEPARTMENT; PROVIDING THAT ALL RESOLUTIONS OR
PARTS OF RESOLUTIONS IN CONFLICT HEREWITH BE REPEALED TO THE
EXTENT OF SUCH CONFLICT; AND PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, HCFA (Health Care Financing Administration) has mandated change in the structure of
transport fees with said change becoming effective April 1, 2002; and
WHEREAS, it is necessary to comply with said mandate.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DANIA
BEACH, FLORIDA:
Section 1. That the following fee schedules for the transport of patients to local hospitals by the City
of Dania Beach Fire-Rescue Department be and the same are hereby approved:
ADVANCED LIFE SUPPORT II
$480.00 plus $25.00 for oxygen plus $7.00 per mile
ADVANCED LIFE SUPPORT I (Emergency)
$360.00 plus $25.00 for oxygen plus $7.00 per mile
BASIC LIFE SUPPORT (Emergency)
$300.00 plus $25.00 for oxygen plus $7.00 per mile
Section 2. That this resolution shall be in force and take effect immediately upon its passage and
adoption.
PASSED and ADOPTED this 26T" day of March, 2002
ATTEST ROB RT CHUNN
MAY R — COMMISSIONER
CIRLENECI& J�H VSON
CITY CLERK
ROLL CALL:
COMMISSIONER BERTINO - YES
COMMISSIONER MCELYEA - ABSENT
COMMISSIONER MIKES - YES
VICE-MAYOR FLURY - YES
1 1 MAYOR CHUNN - YES
WTHOMAS J. AN'SBRO
CITY ATTORNEY
Resolution No. 2002-039
CITY OF DANIA BEACH
FIRE-RESCUE DEPARTMENT
INTER-OFFICE MEMORANDUM
TO: Ivan Pato, City Manager
FROM: Kenneth Land, Fire Chief
RE: Agenda — March 26, 2002
DATE: March 19, 2002
Due to mandated HCFA (Health Care Financing Administration) changes in fee structures,
we have found it necessary to revise our current transport charges. Attached is information
relating to those changes which are to become effective April 1, 2002, together with a
"Comparative Fee Schedule" prepared by Advanced Data Processing, Inc., our present
billing agent. Accordingly, also submitted to you herewith is form of resolution reflecting the
• mandated changes.
For your further information, our ;resent fees are $300.00 for both Advanced Life Support
and Basic Life Support plus $25.00 for oxygen and $7.00 per mile.
If the foregoing meets with your approval, I hereby request that this matter be placed on the
March 26, 2002 regular city commission meeting agenda.
If anything further is needed, please let me know.
KL:clb
attachments
cc: Charlene Johnson, City Clerk w/attachments
Volume 3, Issue 1
March, 2002
s
HCFA Mandated Change - New Fee Structure
Our communications with you previously concerning the anticipated HCFA Fee Structure changes were tentative
and uncertain until we would receive explicit instructions from Medicare.On February 27 h,2002 the Final Rule of
the Negotiated Ambulance Fee Schedule was published.
Purpose
The purpose of this communication is to update you on the absolutely essential elements required for
implementing changes in your operations and ours in order to adapt and comply with the change in the updated
federal regulations. Much of the information was communicated to you on previous memos and newsletters. In
this communication we will highlight the important changes and to what you should pay extreme attention.
The following rules are scheduled for implementation April 1,2002.
Basic Services—Service Definitions
The new Fee Structure provides seven categories for service reimbursement adding some new levels and changing
the definition of existing service levels.Understanding this is critical since this will impact the definition of service
levels by your personnel.
• New service levels must be specified by your organization (on the runsheet submitted for billing)and should be
QA'd as most organizations are already doing. You must identify to us which of the basic service levels were
performed — BLS, ALSI, ALS2 & SCT. These levels must be differentiated on the basis of the definitions
provided.
SERVICE LEVEL DEFINITIONS
Service levels are as defined below and are based on State and Local Laws. The National EMS Education
&Practice Blueprint is no longer the governing definition.
BASIC LIFE SUPPORT(BLS): There was some confusion in the Proposed Rule about including IV therapy
in the basic life support payment.The Final Rule makes it clear that IVs are included in the BLS base rate
ONLY in those states(such as Florida) where EMTs may start 1Vs under state or local law. Please note:
If an IV was started and no meds or fluids were pushed or,fluids were used only for the purpose of keeping
the IV open,the IV is considered BLS. Otherwise, ifineds or fluids are pushed, the IV is considered an
ALS procedure(counts towards either ALS 1 or ALS2).
ADVANCED LIFE SUPPORT 1 (ALS1): An ALS 1 level of service is defined as including an ALS
assessment OR the provision of at least one ALS intervention(see definition below). Performing a
medically necessary ALS assessment qualifies the trip as ALS regardless of whether ALS services are
provided during transport.ALS assessments will be recognized only in emergency response situations.
• You will be entitled to the ALS 1 level of service even if you only performed a
medically necessary ALS assessment and no other intervention was required(providing
the ALS assessment was necessary to establish patient condition). In other words,medical
• necessity must be documented and is the issue,not the matter of department protocol.
• Administration of Oxygen does not qualify as an ALS intervention.
• If a BLS and ALS unit both arrive to care for the patient, and after a medically
necesrmy ALS assessment is performed it is determined that the patient does not need ALS
• Page 2 March 13,2002
care,the transporting BLS unit will be entitled to payment at the ALS 1-Emergency rate even
if no paramedic rides on board with the patient. .
• ALS Assessment must be performed by an ALS crew (qualified to perform
assessment),must be in the context of an emergency response and,does not require an ALS
intervention.
• ALS Intervention is defined as a procedure performed beyond the scope of an
EMT-Basic or as defined by state and local law.
ADVANCED LIFE SUPPORT 2 (ALS2): An ALS2 level of service has been clarified to mean the
administration of at least three medications OR the provision of at least one of the following procedures:
— manual defib/cardioversion;
— endotracheal intubation;
— central venous line;
— cardiac pacing;
— chest decompression;
— surgical airway;
— intraosseous line.
In addition,the following apply with regard to ALS2:
• Medications must be administered by intravenous push/bolus or by
continuous infusion to satisfy the "three meds rule".
• Medicare will now permit three administrations of the SAME qualifying
medication to satisfy the"three meds rule".
The following are meds that DO NOT qualify for the"three meds rule":
® • Crystalloid, Hypotonic or Hypertonic Solutions,
• Dextrose,
• Normal saline,
• Ringer's lactate,
• Oxygen,
• Aspirin.
SPECIALTY CARE TRANSPORTS(SCTs): An SCT is the transport of a critically injured or ill
patient who requires on-going care beyond the scope of an EMT-Paramedic. An ambulance service will be
eligible for payment at the SCT rate if it performs a transport of a patient requiring on-going care by:
• health professionals in an appropriate specialty area,
• nursing,
• emergency medicine,
• respiratory care,
• cardiovascular care, or
• a paramedic with additional training.
There is no prescribed certification,curriculum, course or number of hours established to determine what
constitutes a"paramedic with additional training" for purposes of being paid at the SCT level. However,
the final rule states that this is determined with reference to state or local authority that governs EMS
personnel in that jurisdiction. Check with your state EMS director concerning this definition.
•
• Page 3 March 13,2002
EMERGENCY DEFnymoN:The new definition of an'emergency mWome;which qualifies for higher payment at the
BLS and ALSI levels,is"responding iminetliately...to a 911 cal]or the equivalent in areas without a 911 call system.
An immediate response is one for which the ambulance supplier begins as quiddy as possible to take the steps necessary
® to respond to the call." Notably,Medicare has deleted the phrase"emergency medical condition"as a requirement for
payment at the emergency rate. Medicare has recognized that ambulance services incur higher costs in being prepared to
respond to emergencies regardless of what the patient's condition ultimately tums out to be. Of course,the patient must
still meet medical necessity requirements for the ambulance service to be eligible for payment,but ifthe ambulance service
"responded immediately"or took the steps necessary as quiddy as possible to respond to the call,it would be entitled to the
higher emergency payment rate(BLS and ALS I levels only).
MILEAGE
The following are important with regard to mileage:
No Estimming-It is against the law to estimate mileage. It is required that actual odomoter mileage be used for
reporting transport mileage.
Rounding- If you are not already doing so,all mileage amounts in tenths of a mile rounded up to the next mile
before being submitted to us. For instance,4.0 miles would remain 4 miles but,4.1 miles would be rounded to 5
miles. Please submit to us the mileage in whole miles.
Miles beyond closest facility—Medicare does not pay for mileage beyond the closest facility if you transport to
another further facility when the closest facility would have been deemed"appropriate". In such case,you must
tell us the facility you passed,the number of miles to the first facility and the number of miles past it to the final
destination.This is so that we may bill it correctly,and after receiving the denial from Medicare,bill the patient.
DOCUMENTATION
The following are important with regard to documentation:
• Zip Codes-As you know,since January,2001 the Zip Code of the Pickup Point has been required. You
must continue to provide this as previously specified.
Diversion—In cases where the transport is diverted past the closest appropriate facility,you must document
the diversion explaining the reason for diversion.
OTHER IMPORTANT ISSUES
ALS MANDATE: In some areas, local law may require that the ambulance service provide all services at
the ALS level. Medicare has recognized these local ordinances as binding and in the past has paid such
ambulance services at the ALS rate even when the patient required only BLS. Medicare will allow this
policy to continue(only for the transition period)by blending the ALS-level payments with the new fee
schedule BLS rates. Codes Q3019/Q3020 have been added for ALS I-emergency and ALS 1-non-
emergency for those who bill all ALS even when no ALS intervention is provided.
MANADATORY AssIGNMENT:Assignment is mandatory under the new fee schedule, but will NOT be
phased in. That means that EFFECTIVE APRIL 1,2002 you must accept the Medicare amount as payment
in full and may only bill the patient for unmet co-payment and deductible amounts,NOT your full charges.
Mandatory assignment will NOT apply to non-covered services. So, for example,you would not be
precluded from billing a Medicare beneficiary for non-covered mileage if you transport them to a facility
that is not the closest appropriate facility under Medicare guidelines. You can also bill beneficiaries
directly for your full charges for other non-covered services like wheelchair vans or ambulance transports
to doctor's offices. In some instances,an advance beneficiary notice(ABN)may be desirable,but the ABN
rules are not changed at all by the fee schedule final rule.
DEAD RULE: The following criteria was set forth in the Final Rule when considering pronouncement of
• death:
• If the patient is pronounced dead by an individual who is authorized by the
State to pronounce death prior to the time the ambulance is called,no payment will
be made.
• Page 4 March 13,2002
• If the patient is pronounced dead by a so authorized person prior to arrival
but after the ambulance is called,you must code this as a BLS emergency
transport(except for air)but no mileage is paid.
• ;ayment
If the patient is pronounced dead by a so authorized person during transport,
rules apply as if the patient were alive.
• For air rescue same rules apply but where payment is made at the air base
rate.
MULTIPLE PATIENTS: If you transport more than one patient(in the same vehicle),the fee schedule regulations
discuss how payment will be apportioned among them. If you transport two patients,Medicare will pay 75%of
the allowed base rate for each patient. If you transport three or more patients, Medicare will pay 60% of the
allowed base rate for each. Mileage will be prorated among the total number ofpatients.You must separate these
transports out for us, as they must be billed differently, identifying them separately as "Multiple Patient
Transports". You must indicate in the narrative the number of patients and we will process these with the new
`GM'modifier.
BED-CONFINED&MEDICAL NECESSITY: For payment to be made, the patient's condition must meet
medical necessity requirements for ambulance transport at the level of service billed. For non-emergency
transports,the patient must be EITHER(1)bed-confined(under the current definition);OR(2)have a
medical condition, "regardless of bed confinement,"such that "transportation by ambulance is medically
required."Therefore,bed-confinement is NOT the SOLE determinant of medical necessity for
non-emergency transports. Other medical conditions may warrant transport, even if the patient is not
bed-confined.
PHYSICIAN CERTIFICATION STATEMENTS: Medicare has changed the rules for physician certification
statements(PCS). This is required for non-emergency, interfacility transports ONLY.
• REPETITIVE PATIENTS-Effective April 1, ambulance services must have a PCS form signed
• by the attending physician INADVANCE of rendering a non-emergency transport for a
REPETITIVE PATIENT(scheduled transports). When obtaining an advance PCS, it must be dated
no earlier than 60 days before the date of service.
• NON-REPETITIVE PATIENTS- For NON-REPETITIVE PATIENTS,and for UNSCHEDULED
TRANSPORTS,the ambulance service must obtain a PCS FROM THE ATTENDING
PHYSICIAN within 48 hours after the transport.
• If the ambulance service cannot obtain a PCS from the attending physician, only then may the
ambulance service obtain a PCS from physician assistant,nurse practitioner,clinical nurse specialist,
registered nurse or discharge planner employed by the facility or by the attending physician(this is a
new provision of the final rule)and with knowledge of the patient's condition. If the ambulance
service cannot obtain the PCS within 21 days after the transport,it may submit the claim if it has
documented its attempt to obtain the PCS. The documentation must be a signed return receipt from
the U.S. postal service(see`Proof of Mailing' PS Form 3877 included in this document)OR similar
service that evidences that the ambulance service made the attempt. Fax attempts are not specifically
mentioned in the text of the final regulation.
The presence of a PCS form does not conclusively mean that medical necessity is met,and it is the
responsibility of the ambulance service to have complete and accurate documentation to
demonstrate that the beneficiary's condition meets the medical necessity criteria.
METHOD 3&4 BILLERS: If you currently bill for supplies separately,you will continue to be
allowed to do so until the fee schedule is fully implemented. In addition,ifyou can currently bill for
waiting time and extra attendants,you can continue to do so until the end of the transition period.
•
e Page 5 March 13,2002
CONDITION CODES: Sadly,Medicare has chosen not to implement the list of ambulance-specific condition
codes that was attached as an Appendix to the proposed rule in September of 2000. However,Medicare
. indicates that ambulance services will be permitted to put condition codes in the"remarks"field of their
claim,but the presence or absence of a condition code will not be dispositive in determining if an
ambulance transport was medically necessary. Medicare has agreed to give the condition codes further
consideration over the next year. (OK,everyone start holding your breath!)
MEDICARE HMOS: If your ambulance service has a contract with a Medicare HMO,the fee schedule does
not affect your payment rates for services rendered to Medicare HMO beneficiaries(unless, of course, the
contract contains a provision tying your payment to the Medicare fee schedule upon implementation).
Questions about the interpretation of your Medicare HMO contract should be referred to your legal
counsel. If you are not under contract with a Medicare HMO, the Medicare HMO is liable to pay the
Medicare allowance amount(less any applicable copayment),and the mandatory assignment rules would
prevent you from balance-billing the patient.
FINANCIAL CONSIDERATIONS:
The new conversion factor(base rate)for ambulance services is$170.54(an increase from the previous
interim rule).
Unadjusted Base Rate(UBR)
Service Levcl Relative Value Unit(RVL) Base Rabe
BIS 1.00 $170.54
BIS Emergency 1.60 $272.86
ALSI 1.20 SM.65
ALSI Finergency 1.90 $324.03
ALS2 2.75 $468.99
SCI' 3.25 $554.26
PI(sane areas of New York Duly) 1.75 $298.45
Ground Mileage
LOADED MILEAGE: $5.47
RURAL MILEAGE Miles 1-17: $8.21
RURAL MILEAGE Miles 18-50: $6.84
5-YEAR PHASE-IN PERIOD: There is now a FIVE YEAR phase-in period instead of a four-year phase in
period as originally proposed. During the phase-in period,your payments will be determined by blending a
portion of your existing payment rate with a portion of the fee schedule payment rate as calculated above.
The phase-in schedule is as follows:
r.. - r.. -
r2002k- , 20% 80%
40% 60%
60% 40%
80% 20%
100% 0%
• Page 6 March 13,2002
CALCULATION OF YOUR BASE RATE:
As in the Proposed Rule,the unadjusted base rates are adjusted based on the Geographic Practice Cost
• Index(GPCI)figures for your particular area,so your actual base rate may vary somewhat from these
figures. The"Practice Expense"portion of the GPCI table is what is provided below to determine your
GPCI. The GPCI is determined by the place in which the beneficiary is loaded onto the ambulance,NOT
by the location of your ambulance service's station or the jurisdiction of the Medicare carrier. GPCI for
your area can be figured from the following table:
Fort Lauderdale 1.022
Nrmni 1.064
Florida(a0 other areas) .947
Atlanta 1.046
Georgia(all other areas) .8%
South Carolina .904
Once you determine your GPCI,your base rate under the new fee schedule is calculated by taking 70%of
the appropriate unadjusted base rate(from one of the 7 levels of service above),and multiplying that by the
GPCI for your area. Then,add in the remaining 30%of the unadjusted base rate to determine the base rate
for your service.
Remember,as discussed below,between April 1,2002 and December 31,2005,your actual payment
amount will be determined by"blending"your fee schedule payment with your existing payment amount.
The fee schedule payment amount will be phased-in in percentages over this time period according to the
phase-in schedule below. As of January 1,2006, it's 100%fee schedule, ready or not!
An important note: If your actual charge,that is the amount you actually bill Medicare for the service, is
LESS than the fee schedule payment, Medicare will pay the lesser of your actual charge or the fee schedule
amount. You should review your charge structures to ensure you are billing at appropriate levels to ensure
you receive the revenue to which you are entitled.
(Note: the first blended year is in effect from April 1,2002-December 31,2002)
SE ING YOUR FM
You should have prepared to change your fees and gone before the board, council, etc. for approval.
Fee table portion of this change will go into effect April 1, 2002. You must look at your existing rates
and evaluate where they need to be relative to the new fee structure and its inherent rates. Rates need to
be raised to recoup from private insurances reduced revenues resulting from:
• Medicare reimbursements for BLS service has been reduced,
• BLS now includes establishment of peripheral IV, and
• Page 7 March 13,2002
In general, we suggest you should look to set your fees at least 10% higher than the rates provided
here by Medicare:
• ,Relative Value Ur t(Rr U)
t� r
Service Leal RVU Ur=Qusted +100/0
amount
BLS 1.00 $170.54 $190
BLS Emergency 1.60 $27286 $300
ALS1 1.20 $WC65 $225
ALS1 Enm gency 1.90 $324.03 $355
ALS2 2.75 $46&99 $515
SCT 3.25 $554.26 $610
What we recommend is the following minimum be set into your fee schedule:
BLS $300
ALS1 $360
ALS2 $480
Please be aware that setting your rates higher will cause your collection percentages to decrease and
your write-offs to increase. However, your bottom-line dollars collected will be higher by raising the
rates. Please also note these are bundled billing numbers. If you bill unbundled(Method 4), you will
• have to figure your base rate on the basis of average billed amounts.
ANALYSIS OF THE MEDICARE AMBULANCE FEE SCHEDULE by Page, Woltberg& Wirth, LLC
(portions used by permission)
Questions or Comments?
Call us at (800) 226-1149 or
e-mail us at
a,dpadv3@beEsouth.net
ADVANCED DATA PROCESSING, INC.
520 N.W. 165th Street Road,Suite 201
Miami, Florida 33169
305-945-2280/800-226-1149
2/14/02 COMPARATIVE FEE SCHEDULE
XPREMS53 ALS1: ALS2: SCT2: BLS: 02: MILES: SUPP:
Brevard $ 275.00 $ 275.00 $ 25.00 $ 5.00 **
Palm Beach $ 325.00 $ 225.00 .00 $ 7.50
Pompano Beach $ 275.00 $ 190.00 $ 27.50 $ 5.75
Oakland Park $ 350.00 $480.00 $ 350.00 $ 24.00 $ 6.50 **
Miami Beach $ 310.00 $ 310.00 $ 30.00 $ 7.50 **
Boca Raton $ 330.00 $480.00 $ 300.00 .00 $ 7.00
Tampa $ 360.00 $500.00 $550.00 $ 330.00 .00 $ 5.00
Lauderdale Lakes $ 310.00 $ 310..00. $ 25.50 $ 6.50 **
Lauderhill $ 295.00 $ 250.00 $ 25.00 $ 6.50 **
Coral Springs $ 300.00 $ 300.00 .00 $ 6.50 **
Plantation $ 300.00 $ 300.00 $ 25.00 $ 6.25 **
Tamarac $ 335.00 $ 310.00 $ - $ 7.00 **
North Lauderdale $ 360.00 $480.00 $ 330.00 $ - $ 7.00
Jacksonville $ 300.00 $ 250.00 $ 35.00 $ 5.00 **
Davie $ 350.00 $480.00 $ 350.00 $ 30.00 $ 7.50
Margate $ 330.00 $480.00 $ 300.00 $ - $ 6.50
Okaloosa County $ 340.00 $480.00 $ 340.00 $ - $ 5.00 **
• Orange County $ 280.00 $ 280.00 $ - $ 6.00
Dania Beach $ 300.00 $ 300.00 $ 25.00 $ 7.00
Hallandale $ 500.00 $500.00 $ 500.00 $ 20.00 $ 7.50
North Port $ 330.00 $480.00 $ 300.00 $ - $ 5.50 **
Cooper City $ 300.00 $ 300.00 $ 26.35 $ 7.25
Ft. Lauderdale $ 330.25 $ 330.25 $ 30.30 $ 7.25
Lighthouse Point $ 360.00 $480.00 $ 330.00 $ 30.00 $ 7.00
Hendry County $ 345.00 $ 345.00 .00 $ 6.00 **
Lee County $ 315.00 $ 315.00 .00 $ 6.05 **
Deerfield $ 350.00 $480.00 $ 350.00 .00 $ 7.00
Highlands County $ 330.00 $485.00 $ 300.00 .00 $ 7.50 **
Maitland $ 315.00 $ 315.00 .00 $ 6.00
Monroe County $ 352.61 $ 352.61 .00 $ 7.14 **
Broward County $ 290.00 $ 290.00 $ 26.35 $ 7.25
Dekalb, GA $ 475.00 $475.00 $ 425.00 $ 36.00 $ 6.50 TWT
Sumter, SC $ 200.00 $ 200.00 $ 25.00 $ 4.00 **
Citrus County EM $ 473.00 $598.00 $ 330.00 .00 $ 7.50 **
Citrus County NE $ 430.00 $ 300.00 .00 $ 7.50 **
Flagler County $ 415.00 $580.00 $ 350.00 .00 $ 7.50 **
Polk County $ 320.00 $ 195.00 $ 20.00 $ 4.00 **
Sarasota County $ 300.00 $350.00 $350.00 $ 215.00 .00 $ 5.00 **
Osceola County $ 390.00 $ 390.00 .00 $ 6.00
Seminole County $ 318.82 $ 318.82 .00 $ 5.04
Kissimmee -RES $ 275.00 $ 275.00 .00 $ 5.00 TWT
Kissimmee N-RES $ 425.00 $425.00 .00 $ 5.00 TWT