July 28, 2008
Waiving Retroactive Beneficiary Cost Sharing Due to Increases in Payment Under MIPPA
The HHS Office of the Inspector General has issued a policy statement that assures Medicare providers, practitioners, and suppliers affected by retroactive increases in payment rates under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 that they will not be subject to OIG administrative sanctions if they waive retroactive beneficiary cost-sharing amounts attributable to those increased payment rates, subject to the conditions noted in the policy statement.
To view the document, go to http://oig.hhs.gov/fraud/docs/alertsandbulletins/2008/MIPPA_Policy_Statement.PDF
Increased Payment for Ground Ambulance Services Under MIPPA
CMS will soon be issuing formal contractor instructions that will incorporate the information contained in this announcement.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was enacted on July 15, 2008. In accordance with Section 146(a) of MIPPA, ambulance fee schedule amounts for ground ambulance services will increase.
The increase will be effective for claims with dates of service on or after July 1, 2008, and before January 1, 2010. Specifically,
- For covered ground ambulance transports which originate in a rural area, the fee schedule amounts are increased by 3 percent; and
- For covered ground ambulance transports which originate in a non-rural area, the fee schedule amounts are increased by 2 percent.
Contractors have been instructed to hold all ambulance claims affected by these changes, and release them for processing upon implementation of the revised fee schedule files. Contractors have also been instructed to identify and, to the extent possible, automatically reprocess any claims that were paid under the pre-MIPPA fee schedule rates and to complete that reprocessing no later than September 30, 2008. There will, however, be some claims that cannot be automatically adjusted (e.g., the initial claim's submitted charge was below the new fee schedule amount). Ambulance providers should contact their claims processing contractor for guidance on obtaining an adjustment of these claims.
In addition MIPAA Section 146(b)(1) makes changes for certain air ambulance services provided July 1, 2008 – December 31, 2009. CMS will be issuing guidance to contractors on how to implement these changes and will send out another listserv message when additional information is available on this provision.
