Below is a sample letter that you may use to send to your senator or representative.

September 23, 2000

The Honorable (Name of Representative or Senator)

I am the [title] of [name of ambulance service] in [city, state]. We provide [describe] ambulance services to our community.

I am writing to urge you to support our request for funding to be added to the Medicare ambulance service fee schedule.

As mandated in the Balanced Budget Act of 1997, the Health Care Financing Administration has recently issued a Proposed Rule establishing a fee schedule for Medicare payment of ambulance transport services. This fee schedule will institutionalize a policy of reimbursing ambulance services at levels dramatically below the cost of providing the service. Additional funding MUST be provided in order to preserve America’s safety net of 9-1-1 ambulance providers. Unlike other health care suppliers, ambulance services must always be ready, on a moment’s notice, to provide care. This fixed cost of readiness is incurred regardless of the volume of transports.

The negative impact of below-cost Medicare payments to ambulance services across the country is acute. These financial losses will severely impact the level of service companies will be able to provide to Medicare recipients. The increased Medicare funding could allow services to become financially independent from the necessary county subsidy that most counties provide in the state of Kentucky.

In order to counteract these rate reductions and below cost reimbursement, there is a critical need for Congress to allocated $190 million in additional Medicare funding in 2001. The additional funding needed over five years is $ 3.5 billion.

Thank you for your support of this critical matter. Please feel free to contact me if you need additional information at [insert your telephone number].

A second letter that was distributed is for us to send to Health Care Finance Administration (HCFA) is critical for the new fee schedule to be effective and accurate. The proposed rule that was sent to the Carriers did not include the Condition codes that the Federal Register included after they were created by the Negotiated Rulemaking panel. These are vital to the ambulance industry so that the levels of service will be based on appropriate reimbursement. We need to have everyone in our service send a letter similar to the one following to HCFA to urge them to include the new condition codes. 

September 23, 2000

Health Care Financing Administration
Department of Health and Human Services
Attn: HCFA-1002-P
PO Box 9013
Baltimore, MD 21244-8013

I am the [title] of [name of ambulance service] in [city, state]. We provide [describe] ambulance services to our community.

In reviewing the recently published proposed rule on the Medicare ambulance fee schedule, we were pleased to learn that the HCFA has received positive feedback on the list of medical conditions developed as part of the Negotiated Rulemaking on the Medicare ambulance fee schedule. However, we were extremely disappointed that the program memorandum recently posted on the HCFA web site containing implementation instructions to the carriers did not include the list of medical conditions.

Since Congress directed the committee to establish definitions for ambulance services that link payments to the type of services, these medical conditions are essential in assuring that we select the correct service level when submitting a claim to the carrier/intermediary.

The determination of medical necessity is a critically important aspect of operating at efficient and compliant Medicare billing office. We believe that it would be extremely difficult if not impossible to implement a new fee schedule without this list of medical conditions included in the rule posted in the Federal Register.. If we are forced to use the old coding system with the new service levels, the resulting disconnect would cause enormous claims adjudication problems.

We urge you to take whatever steps are necessary to implement the medical conditions at the same time as the new service levels.