GEMT Reporting and Consulting
Who does GEMT benefit?
The revenue generated in this fund helps departments that have a high rate of Medicaid ambulance use. If you have a high percentage of Medicaid transports, that works for you.
What is GEMT?
GEMT is the acronym for the Ground Emergency Medical Transportation program, which allows public providers to receive supplemental payments above the fee schedule rates they currently receive. However, they can only receive reimbursement if their cost to provide the services exceeds the reimbursement the providers currently receive, based on the HFS fee schedule. These additional payments are for Medicaid patients only.
What are the GEMT guidelines?
Each state has its own guidelines, but to participate in the program, the agency completes a cost report that determines a cost per transport for the charging agency. That cost report is required every year, even if a provider is currently participating in the program.
The cost report and IGA is submitted to the State before October 1 each year in order to be eligible for GEMT funding the following year.
How does it affect PBS Clients?
Based upon the average from our agencies, HFS has determined the actual cost to provide ambulance service is about $2,500 for each transport. Most of our clients receive about $400 for ALS transports and $350 for BLS transports. GEMT is designed to close that gap.
How do we get started?
For Illinois agencies to participate, an Intergovernmental Agreement (IGA) is required and would need to be approved by the agency.
How much would we recoup?
Per the IGA, 50% of the incremental difference is invoiced and reimbursed to the State on a quarterly basis. However, for legal and ethical issues, the agency should not bill a Medicaid patient any more than is billed for other patients. The current billing rates per should be changed to meet the actual cost of providing service, as determined by the cost report. The average cost per transport for our Illinois agencies is
$2,500.
For additional questions, please contact PBS Client Liaison Tom Deegan at tdeegan@paramedicbilling.com.
Where does GEMT help the providers?
- An average Medicaid payment was $120.00 per trip.
- Actual cost of transport was determined to be $2,478.26 per trip.
- $2,478.26 – $120 = $2,358.26 is a difference of the cost of the call, minus the 50% State Reimbursement.
Why is GEMT worth the extra work?
Medicaid payment rates for ambulance services are often 70 percent less than the cost of providing those services.
How will PBS help with GEMT?
PBS will assist in keeping, maintaining, and have readily retrievable, documents to determine what providers are eligible to receive. These records will fully disclose reimbursement amounts to which the Eligible GEMT Provider is entitled, as well as any other records required by CMS.
For clients completing their cost report, PBS will provide the information needed for Schedules 8 and 9.
If your reporting period changes, please let us know as soon as possible. Otherwise, the report will be sent to the department as soon as it is completed.
Thank you!!
