EMS Reimbursement Update| March 2013

Sequestration and Medicare  *UPDATED

Due to the continuing budget gridlock in Congress, sequestration or a wide range of federal program budget cuts, including Medicare payments to providers and health plans.

Under special sequestration rules for Medicare, the reductions are capped at 2 percent of payments and plans for each year of sequestration.

These reductions are scheduled to apply to Medicare Part A and B payments beginning for services rendered April 1, 2013.

*CMS has released a publication stating that the reductions will be applied to provider’s Medicare payments after the patient’s coinsurance and deductible have been calculated.

For example, if the allowable is $100.00.

The co-payment is calculated at 20% or $20. Medicare’s payment was – pre-sequestration supposed to be $80.00 (80% of the allowable). NOW, post-sequestration, the $80.00 will be reduced by 2% ($1.60). So instead of the Medicare payment being $80.00, it will be $78.40. The patient’s coinsurance will remain the same ($20.00).

EMS|MC will keep you informed of any changes to the Ambulance Fee Schedule as they are published by CMS and Congress.