Transportation
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Medicaid non-emergency medical transportation (NEMT) and ambulance services are important benefits for beneficiaries who need to get to and from medical services but have no means of transportation. Myers and Stauffer has assisted states with various aspects of their Medicaid NEMT and ambulance transportation programs, including policy analysis, developing or updating rates, designing and implementing supplemental payment programs, and evaluating NEMT broker programs.

We provide the following services:

Medicaid Financing and Reporting

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Tim Guerrant, CPA
member
tguerrant@mslc.com

317.846.9521

State Medicaid programs are increasingly looking to supplemental payment programs to provide additional reimbursement to ambulance providers to ensure adequate access to emergency ambulance services. These programs often rely on state share funding strategies to leverage federal matching funds. Our team has assisted states in successfully designing and implementing ambulance supplemental payment programs in fee-for-service and managed care environments. Our services include:

  • Design supplemental payment programs and payment methodologies.
  • Develop cost reporting tools and collect cost data from providers.
  • Analyze state share funding strategies.
  • Develop federally-compliant payment structures in managed care.
  • Calculate fiscal impact estimates.

Rate Setting

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Tim Guerrant, CPA
member
tguerrant@mslc.com

317.846.9521

Myers and Stauffer’s rate setting expertise includes rate and payment development for NEMT and ambulance services. Services we provide to our clients for their NEMT and ambulance programs include:

  • Stakeholder engagement.
  • Policy and benefit analysis.
  • Rate adequacy studies.
  • Develop cost reporting tools and collect cost report data from providers.
  • Conduct research and analysis of reimbursement rates and service utilization.
  • Update transportation fee schedule rates.
  • Calculate supplemental payments.
  • Implementation assistance.
  • Socialization planning.
  • State plan/regulation amendments.

Benefit/Program Integrity

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Ryan Farrell, CFE
Principal
rfarrell@mslc.com

512.342.0800

Many of our government health care clients offer transportation services to and from covered medical services. Myers and Stauffer understands the oversight risks and challenges experienced by state agencies associated with offering transportation services, and we acknowledge the unique challenges faced by state agencies as many transition into offering services through a transportation brokerage model. Our work includes assessing and ensuring compliance with contract terms and provider credentialing standards, as well as limited- and full-scope reviews of transportation provider records focusing on documentation and coding standards. Our team can aide clients with documentation and coding determinations related to emergency versus non-emergency and advanced life support versus basic life support transports. Our work also includes performing data analytics to identify potentially aberrant billing patterns, perform detailed peer comparisons by provider type and specialty, and isolate claims that exceed service limitations. Our program integrity services include:

  • Claims analysis.
  • Post-pay claims audits – clinical and financial.
  • Pre-pay claims audits – clinical and financial.
  • Medicaid recovery audit contractor services.
  • Software modules for surveillance and utilization review subsystem (SURS), fraud and abuse detection services, and case tracking.
  • NEMT broker oversight.
  • Provider compliance.
  • Payment system processing accuracy.
  • Fraud, waste, and abuse detection litigation support.

Managed Care Oversight and Compliance

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Mike Johnson, CPA, CFE
Member
mjohnson@mslc.com
404.524.0775

The extensive services offered by our highly skilled managed care engagement team are generally focused on the oversight of health plans but can impact all provider types, including ambulance and transportation providers. These services include:

  • Encounter data reconciliation and validation.
  • Financial audits, performance audits, and program effectiveness audits.
  • Network adequacy assessments and member access compliance.
  • Readiness reviews.
  • Claims payment and denial assessments, accuracy, and timeliness.
  • Medical record review.
  • Grievance and appeals analysis.
  • Contract compliance.
  • Other provider-specific issue review and resolution activities.