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New Payment Model Brings Options to Medicare’s Ambulance Providers

More than 200 emergency transport providers have been selected by the Centers for Medicare & Medicaid Services (CMS) to participate in a new payment model that reimburses Medicare-enrolled ambulance providers who respond to 911 calls and offer treatment services on site or through telehealth services. 

The payment model is called Emergency Triage, Treat and Transport (ET3). The goal is to reduce the number of unnecessary emergency transports to hospitals by reimbursing providers and ambulance care teams for directly addressing the needs of Medicare Fee-for-Service beneficiaries after a 911 call.

These efforts could generate big savings for Medicare and its share of the $32 billion in annual costs that the U.S. health care system spends on avoidable emergency room visits. 

The payment model is voluntary and is set to last for five years. 

How the ET3 model works

When an ET3-participating emergency transport provider arrives at the scene of a 911 call, they have the option of transporting the patient to a hospital or to an alternative nearby facility such as an urgent care clinic.

The ambulance team can also choose to contact a provider via telehealth services, thus avoiding an unnecessary ambulance transport, which can be costly. 

Under the new payment model and its expanded ambulatory requirements, these additional options will be reimbursed by Medicare. Plus, providers that opt in to the ET3 program and use a value-based payment model can potentially see higher rates of reimbursement. 

Value-based care (VBC) reimburses providers based on positive patient outcomes as opposed to simply the number of services rendered. With the additional treatment options being reimbursed by Medicare, providers can route patients to the most appropriate care destination and maximize their potential for a VBC reimbursement. 

Medicare covers some ambulance services

Ground ambulance transportation is covered by Medicare Part B when a patient must be transported to a hospital or skilled nursing facility for medically necessary treatment and when transportation by any other means could be dangerous to the patient’s health.

In these cases, the Part B deductible ($198 per year in 2020) and Part B coinsurance (20 percent of the Medicare-approved amount) apply.

Some Medicare Advantage plans may cover non-emergency transportation

Some Medicare Advantage plans (Medicare Part C) cover non-emergency medical transportation, which may include things like trips to your doctor’s office for a regular appointment.

Medicare Advantage plans are required to also cover everything that Original Medicare (Part A and Part B) covers, which means that Medicare Advantage plans already cover ambulance transportation in the case of emergencies.

You can learn more about Medicare Advantage plans and compare the plans that are available where you live by calling to speak with a licensed insurance agent. You can also compare plans online for free, with no obligation to enroll.

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