|Seniors living in three states will need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments.|
The change, which begins today, is part of a three-year pilot to combat extraordinarily high rates of fraudulent billing by ambulance companies in Pennsylvania, New Jersey and South Carolina.
The good news is that Medicare beneficiaries in those states will now know beforehand whether the program will cover their non-emergency transportation to treatments. The bad news, say advocates, is that many fragile people will be left with no way to get to appointments that might mean the difference between life and death.
“Often people have to go long distances, they feel lousy when treatment is over, and in some cases, it’s to the point of being dangerous in providing their own transportation,” said Jon Burkhardt, a consultant who has studied transportation for dialysis patients.
The pilot is part of a move by Medicare to require prior approvals for services and equipment associated with a high incidence of fraud, such as wheelchairs, chiropractic visits and plastic surgery. Officials said the three states were selected based on “high utilization and improper payment rates.”
If cost savings are shown, the program is expected to be expanded nationally.
Kate Kraemer, billing manager at Direct Bill Inc., which helps a Pennsylvania ambulance firm collect Medicare payments, said the...