A new Government Accountability Office report on what ambulance companies charge Medicare for emergency and non-emergency ground transport, such as taking patients to dialysis clinics, shows that providers' costs per transport varies widely.
The median cost per transport in GAO's sample was $429, ranging from $224 to $2,204 per transport. Provider characteristics that affected cost per transport were volume of transports (including both Medicare and non-Medicare transports), intensity of transports (the proportion of Medicare transports that were non-emergency), and the extent to which providers received government subsidies. Higher volume of transports, higher proportions of nonemergency transports, and lower government subsidies were associated with lower costs per transport.
Ground ambulance transports for all Medicare fee-for-service beneficiaries grew 33% from 2004 to 2010. according to the GAO. Transports by beneficiaries nationwide grew the most in super-rural areas (41%) relative to urban and rural areas. The increase overall is attributable primarily to an increase of 59% over this period in basic life support (BLS) nonemergency transports. In comparing this growth by service area, BLS nonemergency transports in super-rural areas grew the most--by 82%.
Representatives from an ambulance provider organization suggested the increase in transports may be from increased billing by local governments. Some local governments that used to provide Medicare transports free of charge may bill Medicare now because of increased budgetary pressures.
The Department of Health and Human Services Office of Inspector General has cited improper payments--which can be the result of billing mistakes--as one potential cause for increases in Medicare ambulance utilization and has stated that the Medicare ambulance transport benefit is highly vulnerable to abuse, with some payments for transports not meeting program requirements.