Webinar
February 28, 2006
Topic: Ambulance Services
Questions & Answers
Question 1: Will transportation indicators eventually become mandatory?
Answer 1: We have not heard anything from CMS that they will be
mandatory. Right now, they are having it
as a voluntary
Question 2: Is there a list of IV Meds that may
be running, for example, Heparin versus V5, that would justify SCT (Specialty Care
Transport)?
Answer 2: We don’t have a list of drugs. Specialty Care Transport is defined as the
transport where the entity on board has
training beyond that of a paramedic.
Look to your own local agency or state agency to determine what
medications would have to be administered by someone with training beyond that
of a paramedic.
Question 3: In the future, we are going to be able to
bill Dialysis transfers for the entire month on our dialysis patients that go
to a facility (non hospital based) and do you have any idea when is that going
to begin?
Answer 3: We have not heard anything to that
effect. As soon as we do, we will post
that information out onto our website under “what’s new”.
Question 4:
We’re wondering if you could tell us how we determine whether or not we
qualify to be categorized as a super rural?
Answer 4: You would go back to the zip code file that we talked about in the
presentation (http://new.cms.hhs.gov/center/ambulance.asp). Look at each individual transport, the point
of pick-up and the zip code as applicable to that. Then you find that zip code on the file on
the CMS website, go over to column 5 and
it will tell you either the B indicator or the R indicator. This will determine whether you qualify for
those bonus payments. It’s not based
where your company is housed or your office; it’s based on it’s individual
point of pick-up.
Question 5: You only labeled out B
for rural. Is there another code for
super rural?
Answer 5: The B is going to give you a bonus
payment on your base rate, and R is going to give you a bonus payment on the
first 17 miles. Any trip over the 50
miles is going to give you the 25 percent increase. So the B is the super rural, and the R is the
rural.
Question 6: Had a question regarding transport indicators C6 (?). We received a call and based upon the
information given at the time of call, we respond as ALS. We ended up transporting BLS. I know we have
to use the ICD-9 code of BLS condition and the second ICD-9 code would be ALS –
dispatch (?) condition. How do we get
reimbursed for those type of calls?
Answer 6: You are going to be reimbursed BLS. It doesn’t mention in the definition of C6
that any assessment took place by the ALS ambulance. It just says that they went out ALS, but they
determined that BLS was the condition and that’s the way they were transported.
Question 7: So are we going to get reimbursed as BLS?
Answer 7: If no ALS service took place. If you, at the time of dispatch, protocols
told you to go out ALS, you got there and you performed ALS assessments, and
then transported BLS, you get paid at ALS.
But when you don’t perform the ALS assessment, all you provided is BLS
services, you are going to get paid BLS.
Question 8:
Would you suggest billing the claim line for non covered services such as oxygen, because they’re bundled in
now, to put those on a claim form so they would go to Secondary Insurance
companies?
Answer 8: It’s not really appropriate to even list them
as a separate service on a Medicare claim
any longer because the definitions of all of our codes say “and the
medically necessary supplies and services”.
Medicare has incorporated all that
you get paid for the base rate. To bill
us with those fragmented out would be inappropriate billing.
Question 9: Where can I get information on
Hospice. I just received a denial from
Medicare because in it says the patient has Hospice? We picked her up at her residence and
transported her.
Answer 9: When you have a hospice
situation, you have to take into consideration the reason you’re transporting
them. If the reason for the transport is
actually the reason that they’re in hospice, then you’re going to bill the
hospice for that transport. If they are
being transported for other services to cover destinations, etc., then you are
going to use modifiers GW, the modifier that would designate this for a non
hospice condition. In addition to your
origin and destination modifier, second position, you are going to put this
hospice modifier.
Question 10:
Patients that are transported to and from dialysis, can the
justification be signed by somebody else besides the doctor?
Answer 10: Any of the people that we listed on the
webinar slide (*see below) can sign that but is not valid for the whole year
because there is a requirement that PCS
can’t be signed more than 60 days before the service. When you have patients in dialysis, you’re going
to have new PCS every 60 days.
o
*Physician, Physician Assistants, Nurse Practitioners, Clinical Nurse
Specialists, Registered Nurse or Discharge Planner employed by the facility and
has personal knowledge of beneficiary’s condition at time of transport
Question 11: My question is with the Fee Schedule for this
year. We’re figuring out what kind of
percentage of adjustment we are going to have.
So you are saying that a correction was posted and they started paying
the correct fees effective 2/9/06 and the adjusted percentage amount would be
what?
Answer 11: There were two incorrect items when fee
schedules were first put out. There was supposed
to be 1) a 2.5 percent increase and CMS made an error in the file and had a 5
percent increase. Also included in the
fee schedule is the Medicare Modernization Act regional fee schedule that is coming into play. For this year, it was 40-60 (40 percent without it and 60 percent with
it) To determine the overpayment, look
at what was paid since January and look
at what is in the fee schedule now on our website. Subtract what was paid from
January 1st to February 7th and you will know how much you were overpaid at
the beginning of the year for each code.
Question 12:
Who pays for chemotherapy patients if they don’t live in a SNF? They
live at their residence ( their home).
Answer 12: They pay for themselves. And you may bill them your normal charge.
Question 13: These chemo patients are not covered by
Medicare Part B? .
Answer 13: If they are going to a free standing chemo
therapy facility, that is not a covered
destination. Based on that criteria alone it is not a covered service by
Medicare.
Question 14: What if the chemo therapy is in the hospital?
Answer 14: If they are admitted to the hospital and could not be transported any
other way due to their condition, it would be covered. Oftentimes we see them taken to a hospital
facility, but the chemo therapy is not being performed as an in-patient – it’s
a doctor’s clinic that is housed on the site of the hospital. That isn’t
covered.
Question 15:
Is there a way I can get a print
out of the training session.
Answer 15: The slides were sent to registered attendees
prior to this program.
Question 16:
You said transfer for chemotherapy is not covered. What if the patient is going from home to
radiation therapy?
Answer 16: No.
Any trip to a physician’s office is not covered by the Medicare
Program. You will note under the covered
destinations, physician’s office is not listed there.
Question 17:
I understand that if a patient is a Part A SNF PPS stay and they go for
wound care, we bill SNF. If they are not
in a Part A stay, and they are going for a vascular assessment, or services not
done in a SNF, or a physician’s wound care facility, doctor’s office, would
that be covered?
Answer 17: When a patient is not in a Part A stay, they
are in a Part B stay. You revert back to the normal rules. You must determine if you have a covered
destination. These transports are not
covered because those are not covered destinations.
Question 18:
Signatures on patients that are not able to sign at the time of
ambulance transport. Generally, we make
two attempts to obtain that signature after the transportation. Some of the carriers actually allow us to
bill without that signature if we are unable to obtain it. Do you allow for that or do you have to have
the beneficiary’s signature or a representative in order to bill for that claim?
Answer 18:
You can go into the CMS internet manual and look for beneficiary
signature requirement. They do address
ambulance specifically there. It does
talk about the fact that you can look to another representative such as a
spouse, a sibling, a child, an adult child, or someone that shows general
concern for the individual such as a neighbor.
They can sign on behalf of the beneficiary. It goes further to talk about ambulances not
having to get signatures in an emergency situations. You can go ahead and bill us if you are unable
to obtain the beneficiary’s signature in those situations. But you do want to document your file of your
efforts to obtain them.
Question 19:
You made mention about patients that are going from their home to a non
hospital based facility for chemotherapy. What if they are going from a home to a
nursing home to a hospital for chemotherapy?
That is a covered services as outpatient bases (?).
Answer 19: If they are admitted as outpatient or
inpatient, then hospital is a covered destination of the program. They would have to meet the general criteria;
e. g., need an ambulance as a form of transportation is indicated.
Question 20:
I need to clarify when a patient is in a nursing home and needs radiation
therapy. We thought we that was able to be billed to Part B.?
Answer 20: If the patient is in a Skilled Nursing
Facility, under a Part A stay, and they are going to a hospital to receive a
radiation therapy, then it is a covered service by Part B. If they are going to receive the radiation
therapy anywhere other than a hospital, it is not covered. And if they are in a Part B stay, it wouldn’t
be covered if it was performed anywhere other than the hospital either.
Question 21: I’ve been getting a lot of denials all of a sudden
saying it is a PPS but it’s not (
Answer 21: NHIC in
Question 22:
As a metaphor: biller has been
billing for all the supplies and services which she read on the questionnaire. I thought people were saying that it was not
appropriate policy; but because they are not contracting providers with any
other entity aside from Medicare and
Medical, does that essentially mean that they have to change their billing
practices and only submit charges to all carriers for base and mileage?
Answer 22: For Medicare, it is inappropriate to fragment out and to
bill Medicare as of January 1, 2006 for anything other than the base rate and
mileage because it’s all incorporated into the base rate.
Question 23:
On 911 calls when we don’t have the patient’s signature, we attempted to
try and get the signature but we failed.
Is there some kind of a criteria for that if you don’t have the
signature we can come back and bill the program for this type of transport.
Answer 23: Yes.
You can go in to CMS Internet only manual and just do a search on
“signature requirement” and underneath the general information for signature
requirements it will discuss specifically what happens for ambulance transport
in an emergency situation. The program
does allow you to make those attempts to get their signature, and if not
possible, you can go ahead and bill Medicare.
You do have to note in your documentation and it would be beneficial to
note on the claim form itself that you have made attempts to get the signature
but were unsuccessful and therefore you billed without it.
Question 24:
We have patients who are Medicare Managed Care, like Health Net
Seniority Plus and Secure Horizon. Are
those entities allowed or will they only
be paying us for base and mileage as well?
Answer 24: They are governed by the same rules that
govern Medicare. Yes, the whole Medicare
Program is now looking at ambulance only as a base rate and mileage and the
codes incorporate all services and supplies as of January 1st.
Question 25:
Back to chemotherapy. You said
that they had to be transferred to a hospital, but then you said they had to be
admitted to the hospital. What actually
is it?
Answer 25: They must be admitted as an outpatient or
inpatient. You want to make sure where
you’re taking that person at the hospital is actually a part of the
hospital. It’s not covered for a clinic
that has purchased space at the hospital
Question 26:
I have a question regarding billing line items. I understand that Medicare only pays base and
mileage. We’re also billing insurance
companies oxygen, waiting time and the rest of the laundry lists. We have those claims separate from Medicare
as the line item charges. Is that ok?
Answer 26: It’s not appropriate to bill any longer. We can even consider that incorrect billing
because these services are now bundled into the base rate. In essence, when you show them as a separate
line item on the claims, you’re billing us twice for it. This is not appropriate for the services
after January 1, 2006. Prior to that you
can show them separately.
QUESTIONS/ANSWERS THAT WERE FAXED
Question 27:
Why are all our claims from hospital discharge and taken to SNF not
being paid? Is that covered?
Answer 27:
We would need to review specific claims in order to determine why ALL
your claims are being denied. This is a
covered benefit when it is reasonable and medically necessary and the reason is
documented. Please contact your local
customer service number to find out the specific reason they are being denied.
Question 28:
Knowing that a wheelchair
transport is not covered by Medicare, how can we get a denial for the ability
to bill PT? The PT insists we bill
Medicare and when we do, we get a denial as to not bill PT?
Answer 28:
You do not need a denial from Medicare to bill the patient for
non-covered services. Since a wheelchair
van is never covered by Medicare, the patient can be billed directly. However, if you need to bill us, use the GY modifier
and indicate on the claim that it was a wheelchair van.
Question 29:
When transporting patients and they are under Hospice; but the transport
is not hospice related, what are the modifiers to bill with?
Answer 29:
GW is the correct modifier to use along with the origin and destination
modifiers.
Question 30:
Could you tell me if there is a list of IV medications that would
substantiate a SCT transport?
Answer 30:
SCT is covered when the beneficiary’s condition requires ongoing care
that must be furnished by one or more health professional, such as a
respiratory care or cardiovascular care during transport. There is no list of drugs.
Question 31: In transporting a
patient to a landing zone by an air ambulance, what would be the correct modifiers
and is this covered?
Answer 31:
Yes, coverage is available for ground transportation to the air
ambulance. You would bill the modifier
from the point of pick up to “I” for Site of transfer.
Question 32: What do you consider as disposable supplies?
Answer 32:
Routine supplies that the ambulances are normally equipped with.
Question 33:
If doing a paper claim, where would the narrative info go?
Answer 33:
Your comments would be entered in Item 19.
Question 34:
Where would the C3 indicator go on a paper claim?
Answer 34:
The C3 indicator is strictly voluntary; however, if you do use them,
they would be submitted in the narrative field.
Question 35:
In the narrative field, are all symbols accepted? for CCT submissions;
e.g., @ < > #.
Answer 35:
I would not suggest you use symbols that Medicare has not
published. Please be specific with the
information supplied in the narrative field.
Question 36:
Where would we find a list of approved disposable items and the fee
schedule for all disposable supplies -
HCPCS codes?
Answer 36:
Page 27 of the Ambulance billing guide provides you with a list of
Payment for Supplies and ancillary services as well as the fee schedule. The ambulance guide and fee schedule can be
found on www.medicarenhic.com,
Question 37:
Current correct oxygen code – A0422 or A0999?
Answer 37:
A0422.
Question 38:
A0422 cannot be billed after January 1st, as it is included
in the base fee, correct?
Answer 38: That is correct.
Question 39:
Are supplies such as oxygen or any disposables still being paid by
Medicare?
Answer: 39:
As of January 1, 2006, supplies are not allowed separately.
Question 40:
I was under the impression that all supplemental charges needed to be
bundled into the base rate for each level of service, and they would not be paid if charged separately as of January
1, 2006, Is this correct?
Answer 40:
You are correct.
Question 41:
What about extra attendant, is it still being paid?
Answer 41:
Extra attendants are allowed if medically necessary.
Question 42:
Are notice of receipt of Privacy practices required prior to
billing? To what extent are we required
to go to obtain these signatures? Mail
one, twice, three times?
Answer 42:
You can submit the claim if you are not able to get the patients’
signature. Please note that in the
patient’s file.
Question 43:
We have patients that have more than one 911 activated call a day. Why does Medicare deny the additional
services as duplicate? We document the
times and the fact that these are second calls in the same day. How can we prevent these denials?
Answer 43:
Please contact your Customer Service Representative for claim specific
information.
Question 44:
Is this training offered live, in person, or just teleconferences?
Answer 44:
Right now, it is offered only as a Webinar. Join our mailing list to find out when we may
offer this presentation in person (www.medicarenhic.com).
Question 45:
In CR 104, what description would be used for transport to a nursing
home after being discharged from a hospital?
Answer 45:
If medically necessary, you would indicate nearest facility (A).
Question 46:
How many attempts are required to obtain patient’s HIPPA signature?
Answer 46:
There are no specific attempt requests required.
Question 47:
With multiple patients, should we adjust the amount before submitting or
add full charge with GM modifier?
Answer 47:
Medicare will pro-rate based on the number of patients. Bill your normal charge.
Question 48:
If we know the trip is the SNF responsibility, do we have to bill
Medicare first?
Answer 48:
No, you should collect directly from the SNF.
Question 49:
1500 Claim form
Answer 49:
That is correct.
Question 50:
What are the definitions for CR 103 values?
Answer 50:
You can contact your local EDI department or your software vendor to
find out what that is.
Question 51:
Are paper claims going to continue to be accepted?
Answer 51:
If you are exempt from billing electronically under HIPPA, then you can
continue to submit paper.
Question 52:
Where on the NHIC website can I find a retraction request for an
overpayment? (
Answer 52:
Contact your representative at (603) 228-652 and she will provide the
link.
Question 53:
Can a transport between two facilities be an emergency? Such as transport out of a
Answer 53:
This depends on if the patient is an inpatient or has been discharged
and if the services are available at the originating facility.
Question 54:
Why would a
Answer 54:
Documentation must show that the service was not available at the
Question 55:
We are a 911 based ambulance, one way only to the scene to
hospital. Are we required to put on our
1500 claim form a narrative?
Answer 55:
If documentation is required for the transport, then yes, you would need
to use the narrative field.
Originally
posted 4/13/06
Revised
5/04/06