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Tag: cost collection

CMS Shares GADCS Walkthrough

Walkthrough of the Medicare Ground Ambulance Data Collection System Video

Watch the short sections or the entire video (2:49:23) for an overview of the Medicare Ground Ambulance Data Collection System (GADCS), which includes the questions that selected ground ambulance organizations must respond to when they report under the GADCS. For more information, see Medicare Ground Ambulance Data Collection System.

Reminders About Reporting:

Ground ambulance organizations selected in Year 1 and Year 2:

  • Beginning in 2023, you’re required to report cost, utilization, revenue, and other information to CMS within 5 months after your data collection period ends. For example, if you report a data collection period of January 1, 2022 – December 31, 2022, you have a 5-month data reporting period after your data collection periods ended (January 1, 2023 – May 31, 2023) to report data.
  • If you haven’t already reported your data and your continuous 12-month data collection period has ended, please report your data to the Medicare Ground Ambulance Data Collection System (GADCS) portal. See Quick Tips on Registration and Requesting Access.
  • Organizations that fail to report may be subject to a 10 % payment reduction.

Ground ambulance organizations selected in Year 3 and Year 4:

  • You’ll begin collecting data in 2023 and reporting data beginning in 2024.
  • You should have received a notification letter from your Medicare Administrative Contractor about this requirement. Notifications were sent to the contact address in the PECOS enrollment record linked to each selected NPI.
  • You’re required to report your organization’s initial data requirement (start date of your data collection period and contact information).
  • If you haven’t already reported your organization’s initial data requirements, provide the information at this website:

CMS Announces Ambulance Services Selected for Year 2 Data Collection

The Centers for Medicare and Medicaid Services (CMS) has announced the names of those ground ambulance service providers and suppliers who will be required to submit their data for year 2 under the ambulance data collection system. To see the list of providers and suppliers selected for year 2, please go to the Ambulances Services Center page of the CMS website and scroll down to “Ground Ambulance Providers and Suppliers Selected to Submit Data in Year 2 (Zip)” or click here to download the file directly.

Those providers and suppliers selected for either year 2 or year 1 will need to capture and report their data for a 12-month period beginning between January 1, 2022 and December 31, 2022. Providers and suppliers will have 5 months from the end of their reporting period in which to submit their data to CMS. CMS delayed the capturing and reporting of ambulance data due to the COVID-19 public health emergency.

CMS Releases Proposed Cost Collection Rule

CMS has released the proposed rule that would establish the ambulance fee schedule cost collection system as required by statute.

The proposed rule sets the foundation for the data collection system for ground ambulances.  It proposes a stratified random sample method, that is very similar to the one the AAA proposed via the work we commissioned through The Moran Company. We are working through the stratification categories, which are slightly different than those we identified.

CMS also proposes the cost and revenue data elements it plans to use.  There are some details in the proposed rule text and others will be in the proposed tool that will be posted the CMS website today.

CMS also proposes the collection period and penalties for failing to report.

While the data collection provision was the key component for ground ambulance services, CMS also proposed changes to the PCS requirement sought by the AAA. CMS is proposing to reference the PCS also as non-physician certification agreements. The agency is further proposing to clarify that the focus is on the certification of the medical necessity provisions and the form of the certification statement is not prescribed.  As part of the non-physician statement, CMS is proposing expanding the staff of you may sign the statement when an attending physician is unable to sign.

AAA Members Can Download Full PDF Summary by Kathy Lester, Esq.

Read the Proposed Rule

Questions?: Contact Us:

If you have questions about the legislation or regulatory initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.

Tristan North – Senior Vice President of Government Affairs | (202) 802-9025

Aidan Camas – Manager of State & Federal Government Affairs | (202) 802-9026

Thank you for your continued membership and support.

Volunteer Labor: Understanding the True Cost of Doing Business

There are three parts to ever story – a beginning, a middle, and an end. Likewise, there are three parts to running an ambulance service (humor me here); clinical staff (beginning) patients (middle) and administrators (end). This comparison is over-simplified, but the point is this – whether you are a 5-person volunteer service or a 5-state ambulance service, it takes the same basic things to operate. When it comes to cost data collection and ensuring organizations like CMS understand the true cost of doing business, we need to make sure we are sharing our individual stories in the same way.

Full-Time ambulance services can likely report the cost of doing business relatively easily. They can run reports on the number of FTEs they have, how much they’re spending in overtime, equipment costs, and so on. Volunteer organizations have a slightly different story. When some hear about an organization that runs on volunteer labor, they mistakenly connect the word volunteer to free or cheap. The true story is that many costs go into operating a volunteer service, and a volunteer workforce is anything but free or cheap. Understanding how to calculate the true cost of volunteer labor is a critical skill for those charged with running a service that utilizes volunteers in isolation or as part of a mixed workforce.

On February 6th, the American Ambulance Association is hosting an Ambulance Cost Data Collection webinar on the topic of volunteer labor and how to calculate the cost of a volunteer workforce.

Some of the items Scott Moore Esq., HR and Operations consultant for the AAA, will review in the webinar are:

• EMS industry volunteer organizational and labor statistics in the United States
• National statistics for calculating the value of volunteer labor
• Methodologies and formulas other Medicare reimbursed healthcare providers must furnish as part of their industry Medicare Cost Reports
• How EMS agency’s use and percentage of volunteer labor has historically impacted GAO reports and reimbursement rates
• Key cost related factors that will be required to report labor costs for volunteers accurately
• The importance of tracking the hours of all volunteers by position.
• Which costs you should include when calculating the cost of volunteer labor and those commonly missed

Calculating the cost of volunteer labor is undoubtedly one of the more difficult, and most important, components of the cost data collection process. This webinar will leave you with a standard formula you can use to calculate the cost of volunteer labor within your service. If you are leading a volunteer organization, you need to participate in this webinar along with the individual or team that looks after your finances.

Looking for more ambulance cost data collection content? Visit You will find both free resources and paid subscriptions are available to fit your budget and help your service prepare for the future of EMS.

Statement on Cost Data Collection for Ambulance Services

For Immediate Release
Contact: Amanda Riordan
Phone: 703-615-4492

WASHINGTON, DC—On October 17, the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), and The Metropolitan Fire Chiefs Association released a joint statement discouraging fire-based providers from endorsing AAA’s proposed ambulance cost collection methodology. While we regret to learn that they do not believe that our method is appropriate for the segment of providers they represent, we respectfully disagree and invite open dialogue as our previous requests to discuss cost collection with the IAFF and IAFC were declined.

The American Ambulance Association membership is composed of ambulance providers of all types and sizes, ranging from non-profit, for-profit, volunteer, hospital-based, county-based, public utility models, and more. We represent 911 ambulance providers in major metropolitan areas, small 911 providers in rural America, and those who provide vital hospital-to-hospital interfacility mobile healthcare throughout the country. AAA encourages all ambulance providers to visit to learn about the extensive research, time, and thought devoted to ensure that our comprehensive recommendations accurately capture data for the full spectrum of providers.

“Regardless of an ambulance organization’s service model, we collectively serve our communities with round-the-clock mobile healthcare. The collection and analysis of accurate cost data for ambulance providers of all types is essential to the future of our industry. If adopted by CMS, AAA’s cost collection recommendations will demonstrate the value of the care that we provide to our patients, as well as open the door for the establishment of forward-thinking payment models that sustain operations and grow innovation. The American Ambulance Association welcomes discussion with fire and other stakeholders. Our door is always open,” said AAA President Aarron Reinert on Monday.

Medicare cost reporting is an exhaustive and extremely technical system that has been in place in other healthcare specialties for many years. While not all ambulance services are Medicare “providers of service,” it has long been clear to AAA that ambulance services would eventually be required to provide cost data to support Medicare reimbursement, especially for purposes of making the add-ons permanent and expanding the benefit to include innovative payment models, including mobile integrated health. As such, our ambulance cost collection leadership began in 2012 with the commission of an extensive independent research study to design a cost model that would be accurate, complete, and minimally burdensome to ambulance providers of all sizes, types, and models. The findings of this study were released in 2014 and form the foundation of AAA’s cost data collection system design.

Following extensive advocacy efforts led by the American Ambulance Association, the Bipartisan Budget Act of 2018 was passed into law in February of this year. This bill included language that extended the ambulance Medicare add-ons for five years. It also required that ambulance services begin collecting and reporting cost data to the Centers for Medicare & Medicaid Services (CMS) in 2020. CMS has the ability to determine certain aspects of how the data is collected as well as the data elements so AAA is working closely with this agency to advocate for the implementation of our survey-based model. It is also clear that given the Congressional instruction to use the cost collection data to assess Medicare rates, the data collection will be aligned with the costs Medicare has the statutory authority to reimburse, but not necessarily all costs suppliers may incur to support the non-healthcare aspects of their services.

It is essential that ambulance providers speak with one voice on this critically important issue.  Inconsistencies in reporting and failure to standardize costs allowable under the Medicare statute will result in data being eliminated and will threaten the sustainability of the program. As such, throughout this lengthy and intensive process, AAA leadership remains open to feedback and focused on the development of and advocacy for a cost collection system that encompasses all mobile healthcare provider types. Learn more at


About the American Ambulance Association (AAA)

The AAA was formed in 1979 in response to the need for improvements in emergency medical services and mobile healthcare. The American Ambulance Association represents hundreds of ambulance services across the United States who provide emergency and interfacility mobile healthcare. The Association serves as a voice and clearinghouse for ambulance services.

50% of EMS Services Submit Data in: -415 Days 19 Hours 21 Minutes 37 Seconds