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Last Modified: 11/15/2017 Location: FL, PR, USVI Business: Part B

Ambulance Services: The Urgency of Proper Documentation (B)

July 11, 2017, webcast follow-up questions and answers

The following questions originated in the above listed event. Visit First Coast University to view the webcast recording external link. The question is followed by the appropriate answer and applicable resources. For additional information or details, please refer to the Ambulance page on our First Coast website.
1Q. If we have hard-coded mileage within our systems to indicate distance from a hospital to a skilled nursing facility (or other site), yet the driver for a transport takes an alternate route or detour that deviates from this pattern, and thus enters a different mileage on a run sheet, what steps should be taken to address this?
1A. As this scenario indicates, the miles traveled for each trip may vary, so a pre-set determination is not advisable. The miles may be measured using multiple tools, but no matter what, the actual mileage traveled for each transport is what should be documented. To ensure consistency, providers should review documentation (i.e., run sheets) and claim detail before submission. Medicare guidelines indicate that for each ambulance service, mileage billed must be reported in fractional units. For trips totaling up to 100 covered miles, providers must round the total miles up to the nearest tenth of a mile. The decimal must be used in the appropriate place (e.g., 99.9). For trips totaling 100 covered miles and greater, suppliers must report mileage rounded up to the next whole number mile without the use of a decimal (e.g., 998.5 miles should be reported as 999). For trips totaling less than 1 mile, enter a “0” before the decimal (e.g., 0.9).
2Q. Regarding an ambulance provider’s response to a call, what is the date of service that should be indicated on the claim?
2A.The date of the transport of the Medicare patient is the date of service that should be placed on the claim, as charges for mileage are based on loaded mileage only.
3Q. Will individual providers receive feedback regarding their status relating to the upcoming ambulance audits?
3A. Beginning on or after August 1, 2017 in Florida, a prepayment medical review audit for Healthcare Common Procedure Coding System (HCPCS) codes A0428 and A0425 with the HN modifier will be implemented based on a threshold of claims submitted for payment. This process will be random, and those providers impacted by this audit will be notified via an additional documentation request (ADR). See the “Widespread probe review for ambulance services” article in the May, 2017 Medicare B Connection pdf file. Information explaining the prepayment review process, including provider notification, is available at IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3 – Verifying Potential Errors and Taking Corrective Actions external pdf file.
4Q. Can an ambulance provider submit a claim even if they can’t obtain the beneficiary’s signature?
4A. Yes. Medicare requires the signature of the beneficiary, or that of his or her representative, for both the purpose of accepting assignment and submitting a claim to Medicare. The IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 20.1.2 lists multiple options relating to how and when authorization can be obtained and submitted.
5Q. In regard to the medical necessity for ambulance services as outlined in the local coverage determination (LCD) L33383 external link (titled “Non-Emergency Ground Ambulance Services”), do all of the points specified have to apply or can just one of the conditions specified qualify for the non-emergency transport?
5A. The LCD provides multiple reasons to allow non-emergency ground ambulance services, providing guidance relating to the meaning of “bed confined” and other scenarios supporting the medical necessity for non-emergency ground ambulance services. It should be noted that although each case may qualify, when considering ambulance services, medical necessity is established when the patient’s condition is such that use of any other method of transportation is contraindicated. In any case in which some means of transportation other than an ambulance could be used without endangering the individual’s health, whether or not such other transportation is actually available, no payment may be made for ambulance services. In all cases, the appropriate documentation must be kept on file and, upon request, presented to the carrier/intermediary.
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