United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2001-11-15 monographic deposited born digital 10 p. GA 1.13:GAO-02-244T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-244T P0b002ee1803940c1 f:d02244t DGPO 2010-08-12 2011-03-23 GAOREPORTS-GAO-02-244T machine generated eng fdlp REPORT GAOREPORTS-GAO-02-244T GAO-02-244T Emergency medical services Ground transportation operations Health care costs Hospitals Medical expense claims Payments Public health legislation Medicare Program Testimony A02465 Medicare's payment and coverage policies for ambulance services are based on reasonable costs for hospital-based providers or on reasonable charges for ambulance providers not affiliated with a hospital or other health care facility (known as freestanding providers). This method has produced wide differences in payments across providers for the same services. Further, there has been considerable variation in Medicare's determinations of what ambulance services are covered and what provider documentation is needed to ensure claims are paid. The Balanced Budget Act of 1997 (BBA) required the Medicare program to change its payment system for ambulance services. In response, the Health Care Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), has proposed a fee schedule to standardize payments across provider types based on national rates for particular services. Under BBA, the fee schedule was to have applied to ambulance services furnished on or after January 1, 2000. HCFA published a proposed rule on September 12, 2000, and has received public comment but has not yet issued a final rule. In this testimony, GAO discusses the unique concerns of rural ambulance providers and the likely effects of the proposed fee schedule on these providers. Many rural ambulance providers face a set of unique challenges in implementing an appropriate payment policy. Rural providers--particularly those serving large geographic areas with low population density--tend to have high per-trip costs compared with urban and suburban providers. The proposed Medicare fee schedule does not sufficiently distinguish the providers serving beneficiaries in the most isolated rural areas and may not appropriately account for the higher costs of low-volume providers. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-244T/html/GAOREPORTS-GAO-02-244T.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-244T/pdf/GAOREPORTS-GAO-02-244T.pdf GAO-02-244T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-244T Testimony GAO-02-244T; Ambulance Services: Changes Needed to Improve Medicare Payment Policies and Coverage Decisions; Emergency medical services Ground transportation operations Health care costs Hospitals Medical expense claims Payments Public health legislation Medicare Program Volume 111 Page 251 111 Stat. 251 Public Law 105-33