Ambulance Cost Data Collection – The Importance of Getting It Right the First Time

The passage of the Bipartisan Budget Act of 2018 (BBA of 2018) not only provided the ground ambulance industry with a five-year extension of the temporary add-on payments (2% for urban, 3% for rural, and 22.6% for super-rural transports) but it also required the industry to provide ambulance cost data beginning January 1st, 2020. It is important for the ground ambulance industry to understand the impact of ambulance cost data collection relative to our current and future federal reimbursement models.

In order to ensure that the cost data collected from the ambulance industry is accurate and reliable, it will require active engagement from the ambulance industry. The BBA of 2018 basically indicated to our industry that we have to justify the permanence of the temporary add-on payments by proving to Congress that Medicare is reimbursing substantially below our costs. While this was indicated in the Government Accountability Office (GAO) reports of 2007 and 2012, they want to see actual data. As Deming coined the phrase “In God we trust, all others bring data”, Congress is telling us to “bring the data.”

The accuracy and reliability of the data are only as good as input. Out of the approximate 12,000 ground ambulance providers and suppliers which bill the Medicare program, 83% billed the Medicare program less than 2,500 ground ambulance transports in 2017. Needless to say, our industry is comprised of small businesses. Our industry composition is comparative to the home health industry which underwent a similar requirement over a decade ago. Unfortunately for the home health industry, the data collection effort initially did not produce accurate and reliable data due to lack of knowledge by the majority of the industry regarding what they were submitting yearly to Medicare. It ultimately resulted in several cuts to their payment rates and put the industry on the defensive in trying to substantiate their costs and correcting the erroneous and bad data submitted.

The ground ambulance industry must learn from the mistakes of others and work together to ensure we do not repeat. Since the passage of the BBA of 2018, the American Ambulance Association, in conjunction with many state ambulance associations, has worked on bringing education and tools to assist ambulance agencies in the cost data collection process that will commence on January 1st, 2020. It is imperative that every agency actively engages in this process. There is no option to say you do not have the time or resources to participate or engage. To put it bluntly, passive participation could lead to active consolidation leaving the communities we serve with fewer resources.

Get involved. Become engaged. Actively participate in ensuring your ambulance system is ready to report cost data if you are selected to provide cost data beginning January of 2020. You can visit the Texas Ambulance Association website to register for the upcoming Cost Data Collection workshop at

For more resources on ambulance cost data collection, please register at

Asbel Montes, BSB
American Ambulance Association Payment Reform Committee Chair
Ambulance Cost Data Collection Faculty Member
Senior Vice President, Acadian Ambulance Service

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