United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2000-07-17 monographic deposited born digital 40 p. GA 1.13:HEHS-00-115 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-115 P0b002ee180387984 f:he00115 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-00-115 machine generated eng fdlp REPORT GAOREPORTS-HEHS-00-115 HEHS-00-115 Health insurance Medical fees Health resources utilization Medical services rates Economically depressed areas Emergency medical services Claims processing Emergency Medical Services Training Program Medicare Program AID Project HOPE North Dakota South Dakota Wyoming Montana North Carolina Letter Report HEHS

Pursuant to a congressional request, GAO reviewed Medicare payments for ambulance services in rural areas, focusing on: (1) the challenges faced by rural ambulance providers; (2) how the upcoming fee schedule will affect rural providers relative to their current situation; and (3) what factors have affected claim denial rates for ambulance services.<p/>GAO noted that: (1) because many rural ambulance providers serve a large geographic area with a low population density, they face a set of unique challenges; (2) unless they rely on volunteers, they tend to have high per-trip costs because of the lower volume of transports as compared to urban and suburban providers; (3) rural providers also tend to have longer ambulance transports than their urban counterparts, making the adequacy of reimbursement for mileage costs more central to their overall payments than for providers in more densely populated areas; (4) in addition, because rural residents may have fewer alternatives for transportation to hospitals, ambulances may transport some beneficiaries whose conditions do not allow for Medicare reimbursement; (5) furthermore, revenue sources are changing for rural providers with an increasing reliance on Medicare revenues; (6) moreover, maintaining volunteer staffs, which are more common in rural than urban areas, is becoming more difficult; (7) the proposed Medicare fee schedule will alter the way rural ambulance providers are paid; (8) much of the variation in payment rates among similar rural providers will be eliminated; (9) some providers that now are paid more than the national average are likely to receive lower payments under the fee schedule; (10) others, including rural South Dakota providers, that are paid less than the national average are likely to receive increased payments; (11) in addition, providers that transport beneficiaries in rural areas will receive enhanced payments intended to help sustain essential ambulance service in sparsely populated areas; (12) however, this adjustment does not sufficiently distinguish the providers serving beneficiaries in isolated areas and may not be applied appropriately; (13) GAO's review of 1998 claims data show that payment denials have varied widely among carriers, which are the contractors that process claims for freestanding ambulance providers; (14) such variation can result in unequal coverage for Medicare beneficiaries; (15) different practices among carriers, including increased attention to potential fraud, differences in local policies, and carriers' failure to apply the coverage criteria appropriately, may have contributed to the variation in claims denials; (16) claims have also been denied because providers did not properly fill out forms; and (17) the absence of a national coding system that readily identifies the beneficiary's medical condition at the time of the transport has impaired providers' ability to convey information to carriers in a way that facilitates review of claims. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-115/html/GAOREPORTS-HEHS-00-115.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-115/pdf/GAOREPORTS-HEHS-00-115.pdf GAO/HEHS-00-115 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-115 Letter Report GAO/HEHS-00-115; Rural Ambulances: Medicare Fee Schedule Payments Could Be; Health insurance Medical fees Health resources utilization Medical services rates Economically depressed areas Emergency medical services Claims processing Emergency Medical Services Training Program Medicare Program AID Project HOPE North Dakota South Dakota Wyoming Montana North Carolina Title 42 Section 1395m(1) 42 U.S.C. 1395m(1) Public Law 105-33