Health care providers of all shapes and sizes have seen an increase in Medicare and Medicaid payment audits after the implementation of the Affordable Care Act and its many provisions for safeguarding Medicare and Medicaid. The Office of the Inspector General at the U.S. Department of Health and Human Services says the Centers for Medicare & Medicaid Services should increase monitoring of ambulance billing. Here is what increased monitoring will look like and how it will impact EMS agencies.
EMS agencies should expect audits to increase in frequency and complexity. A September 2015 study released by the OIG found that roughly 1 in 5 ambulance providers had questionable billing practices.
The study recommended that CMS increase its monitoring of ambulance billing. This will come in the form of billing audits in which EMS agencies will be required to justify, through appropriate documentation, that their claims are legitimate. If agencies cannot, they will face potentially large paybacks — returning Medicare and Medicaid payments. Read the full article here