Current EMS Reimbursement
According to the Government Accounting Office, Medicare reimbursement to EMS services per transport falls below the costs incurred for providing this essential service. Reimbursement for these services under state Medicaid programs falls even further below the true cost of the care delivered.
Medicaid Payment Enhancements
Some states make substantial additional payments to providers above the Medicaid fee schedule amounts for individual services. Federal regulation limits those payments (often referred to as the “Upper Payment Limit” or “UPL”) to the “prevailing charges in the locality for comparable services under comparable circumstances.” Frequently, this is established by surveying the amounts which commercial payers allow for the services. In other words, the maximum amount of potential enhancements is the difference between Medicaid and commercial insurance payments.