Medical Review of Ambulance Services. Provider Outreach & Education and Medical Review October 2014

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Medical Review of Ambulance Services. Provider Outreach & Education and Medical Review October 2014"

Transcription

1 Medical Review of Ambulance Services Provider Outreach & Education and Medical Review October 2014

2 Before We Start Help Us Help You! CHAT Area Enter name, facility name and state do not enter in Q&A section Dial into teleconference using assigned Attendee ID number rather than just # sign Check Event Info tab for ID 10/15/2014 2

3 Workshop Protocol When entering/throughout workshop all lines muted Presentation ed 3 days before webinar Adobe PDF format (with printing instructions) Throughout workshop Questions pertinent to workshop slide addressed Address Q & A to all panelists ; not to host directly All other questions, call Part A Provider Contact Center Workshop conclusion Asking questions aloud? Use raise/lower hand feature MUTE phones never place on HOLD 10/15/2014 3

4 Continuing Education Unit (CEU) When registering, add additional attendees First and last names Attend entire workshop Take short polling survey After closing out of webinar CEU ed 3 days after presentation Earn between.5 and 1.5 CEUs No password or index number needed All providers use CEU certificate Certificate of Attendance no longer available 10/15/2014 4

5 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and CMS. The most current edition of the information contained in this release can be found on the Noridian website at and the CMS website at The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2014 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 10/15/2014 5

6 Agenda Medical Necessity Covered and Non Covered Transports Ambulance Service Levels Medical Review Errors and Findings Questions Resources 10/15/2014 6

7 Objective Assist Medicare Part A ambulance providers in better understanding ambulance transport, billing, coding and coverage Provide documentation requirements from Noridian Medical Review s findings Equip providers with helpful resources 10/15/2014 7

8 Medical Necessity

9 Medical Necessity Internet Only Manual , Chapter 10, Section states: 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. 10/15/2014 9

10 Medical Necessity Internet Only Manual , Chapter 10, Section states: It is important to note that the presence (or absence) of a physician s order for a transport by ambulance does not necessarily prove (or disprove) whether the transport was medically necessary. The ambulance service must meet all program coverage criteria in order for payment to be made. 10/15/

11 Bed Confined Internet Only Manual , Chapter 10, Section states: Bed-confinement, by itself, is neither sufficient nor is it necessary to determine the coverage for Medicare ambulance benefits. It is simply one element of the beneficiary's condition that may be taken into account in the intermediary's/carrier's determination of whether means of transport other than an ambulance were contraindicated. 10/15/

12 Bed Confined Bed confined alone does not determine medical necessity All three must be met before and after transport, not just at the time of transport: Unable to get up from bed without assistance Unable to ambulate, and Unable to sit in a chair or wheelchair Includes wheelchair, geri chair, dialysis chair and recliner 10/15/

13 Bed Confined This is NOT synonymous with: Non-ambulatory Stretcher bound or Bedbound Bedrest Bedfast Bedridden 10/15/

14 Oxygen Oxygen administration alone does not necessarily make a trip payable Documentation needs concise explanations for why the respiratory status may be compromised and why skilled personnel are needed for monitoring patient en route 10/15/

15 Oxygen Documentation needs to show: Amount of oxygen transported with Application route of oxygen The spo2 taken by EMS (not from the hospital before EMS arrived) Respiratory rate Lung sounds 10/15/

16 Oxygen Patients with chronic respiratory problems generally have lower spo2 readings than the general population. In some cases, it is contraindicated to apply/increase oxygen to achieve a higher spo2 10/15/

17 Physician Certification Statement (PCS) Does not determine medical necessity alone Completed form does not guarantee coverage 10/15/

18 Physician Certification Statement (PCS) Not required for emergency services Non-emergency transports MAY require a written order certifying medical necessity 10/15/

19 Physician Certification Statement (PCS) Advanced certification required for repetitive scheduled transports Obtain prior to transport, but no more than 60 days before the date the service is furnished 10/15/

20 Physician Certification Statement (PCS) The signature of the person signing the PCS must be legible and include a title If unable to obtain completed PCS form within 21 days Document attempts Claim can be submitted without 10/15/

21 Physician Certification Statement (PCS) Each PCS should be personalized to each patient and match the patient s condition at time of transport. Reasons for ambulance transport on the PCS must be supported by the documentation 10/15/

22 Physician Certification Statement (PCS) An addendum should not be added to the PCS to make the ambulance trip payable 10/15/

23 Covered and Non Covered Transports

24 Basic Medicare Coverage Transportation by any other means could pose a threat to the beneficiary s survival or seriously endanger their health Based on the beneficiary s medical condition at the time of transport Medical diagnosis alone may not make trip payable 10/15/

25 Basic Medicare Coverage To the nearest appropriate facility capable of providing care needed If needed, Medicare may pay for unusual circumstances requiring further distance to another appropriate facility 10/15/

26 Basic Medicare Coverage Transport by approved ambulance service For Part A coverage, ambulance services are furnished under arrangements by participating hospitals, skilled nursing facilities, and home health agencies 10/15/

27 Return Transports Usually not reimbursed Must meet medical necessity Treated and released patients could go by other means Specialized services of ambulance crew usually not required 10/15/

28 Non Covered Transports The Medicare payment benefit for ambulance services is very restricted Providers must understand the benefit and refrain from seeking Medicare payment for services that do not conform to the limited benefit requirements 10/15/

29 Non Covered Transports Claims denied as not medically necessary are beneficiary liable for payment of the bill 10/15/

30 Non Covered Transports Invalid reasons to transport by ambulance: Non-emergency situation with no other means of transportation available Neighbors, taxis, friends, relatives Stretcher/wheelchair van service not available Family requesting ambulance services 10/15/

31 Non Covered Transports Use modifier GY (statutorily excluded; beneficiary liable) if transport by an ambulance occurred but it is known it will not meet Medicare payment benefit 10/15/

32 Advance Beneficiary Notice of Non Coverage (ABN) ABN rare for Ambulance Notice to patient of possible denial - not reasonable and necessary Protects your rights and changes financial responsibility May be used for nonemergency transports Signed and dated before rendering service Modifier GA No changes allowed to form except letterhead 10/15/

33 Extenuating Circumstances Must document extenuating circumstances that prohibit transport to the closest appropriate facility Blizzard conditions Heavy fog Extensive road construction Specialist/equipment not available Hospital on diversion Beds not available 10/15/

34 Locality: Facility Locality Service area surrounding the institution Institution provides care for the illness/injury Appropriate equipment and staff for patient s condition Unusual circumstances requiring further distance to an appropriate facility must be explained in the trip notes and remarks section of the claim 10/15/

35 Transfers: Facility Transfers Medicare does not pay for transportation from one institution to another unless: Discharging institution does not have appropriate facilities for treating the patient Admitting institution was the nearest with appropriate facilities/specialists 10/15/

36 Not covered: Facility Transfers Convenience transfers (family/patient want a different facility) Transfers for a particular provider Nursing Home (NH) to NH Skilled Nursing Facility (SNF) to SNF 10/15/

37 Transports To/From Hospice Care If the medical condition of the patient at the time of transport is related to the patient s hospice diagnosis, then the claim is to be submitted to hospice If transport is unrelated to the hospice patient s terminal condition, submit with a GW modifier 10/15/

38 Ambulance Service Levels Ground and Air Transport

39 Ground Service Level Overview (refers to both land and water) HCPCS Code Short Description Long Description A0428 BLS Basic Life Support, non-emergency transport A0429 BLS-Emergency Basic Life Support, emergency transport A0426 ALS1 Advanced Life Support, non-emergency transport, level 1 A0427 ALS1-Emergency Advanced Life Support, emergency transport, level 1 A0433 ALS2 Advanced Life Support, level 2 A0434 SCT Specialty Care Transport A0432 PI Paramedic Intercept Does not apply to Noridian providers Only in New York A0425 Ground Mileage Ground mileage, per statute mile 10/15/

40 Specialty Care Transport (SCT) Internet Only Manual , Chapter 10, Section states: SCT is the interfacility transportation of a critically injured or ill beneficiary by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic. 10/15/

41 Specialty Care Transport (SCT) Use caution to avoid confusing chronic illness with critical illness or injury Must be furnished by one or more health professionals in an appropriate specialty Emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training 10/15/

42 Specialty Care Transport (SCT) Generally a transfer to a higher level of care Transfers to a lower level of care, such as rehab or subacute care, generally do not meet the critically ill or injured criteria Ground services only 10/15/

43 Specialty Care Transport (SCT) Documentation must support illness/injury severity and that the health professionals are doing interventions May not qualify for SCT by itself: nurse on board or patient on a ventilator for example 10/15/

44 Air Service Level Overview HCPCS Code Short Description Long Description A0430 A0431 Fixed wing air transport Rotary wing air transport Conventional air services, transport, one way (fixed wing) Conventional air services, transport, one way (rotary wing) A0435 Air mileage, FW Fixed wing air mileage, per statute mile A0436 Air mileage, RW Rotary wing air mileage, per statute mile 10/15/

45 Air Transport Air service coverage is furnished when medical condition required immediate and rapid ambulance transport that could not have been provided by ground The point of pickup (POP) is inaccessible by land/water, or Great distances or other obstacles are involved 10/15/

46 Air Transport Special Payment Limitations (CR 7161) If ground transport would have sufficed, Medicare will pay the ground ambulance rate 10/15/

47 Mileage Beyond Closest Facility A0888 Line item for non covered mileage Need Origin/Destination modifiers and QN modifier GY modifier Is it provider liable? Leave GY off of claim 10/15/

48 Mileage Beyond Closest Facility Example Scenario: Residence to closest appropriate hospital: 14.3 miles Patient transported to a different hospital 46.8 miles from residence Bill should look like this: A0427 QNRH, 1 unit A0425 QNRH, 14.3 units A0888 QNRHGY, 32.5 units 10/15/

49 Modifiers QM = Ambulance service provided under arrangement by a provider of services QN = Ambulance services furnished directly by a provider of services 10/15/

50 Origin/Destination Modifiers D E G H I J Diagnostic or therapeutic site (other than P or H) ASC and IDTF Residential facility, domiciliary, custodial facility, assisted living, group home Hospital-based dialysis facility (ESRD) Hospital Site of transfer (airport, helicopter pad) Non hospital-based dialysis facility (ESRD) 10/15/

51 Origin/Destination Modifiers N P R S U X Skilled nursing facility (swing bed, hospice) Physician s office (freestanding ER non hospital-based, urgent care, clinics) Residence (private only) Scene of accident or acute event (origin only) Unclassified ambulance service Intermediate stop at physician s office on way to hospital (destination only) 10/15/

52 Misuse of Modifier 22 Medical Review has noticed a trending of providers using Modifier 22 on Ambulance Claims. Modifier 22 documents work required to provide a service was substantially greater than the work typically required Modifier 22 should not be appended to an Ambulance claim 10/15/

53 Medical Review Errors and Findings

54 Error: Medical Review Errors - Return Trip to SNF/Home - Many are not medically necessary Physician or Social Services ordered the trip but medical necessity not met An order alone does not allow coverage of ambulance transport for Medicare benefit payment. The patient must meet medical necessity. Submitting a Physician Certification Statement (PCS) does not guarantee payment 10/15/

55 Error: Medical Review Errors - Return Trip to SNF/Home - PCS does not give a clear indication of why an ambulance was needed PCS or ambulance crew reference the patient s admitting/acute state rather than the current condition at discharge 10/15/

56 Error: Medical Review Errors - Medical Necessity - Documentation does not support that travel by other means would endanger the patient s health Documentation does not support necessity of traveling beyond closest appropriate facility Description of the patient on the Physician Certification Statement does not match the condition in the trip sheets 10/15/

57 Medical Review Errors - Return Trips and Medical Necessity - Solution: Clear, legible documentation EMT/Paramedics need to be descriptive of the beneficiary s condition 10/15/

58 EMT/Paramedic Documentation Relevant, clear and concise facts relating to patient s condition Do not document the Physician Certification Statement verbatim into their narrative note Justify why an ambulance was the only means of transport 10/15/

59 EMT/Paramedic Documentation If it s not documented, Medicare considers it not done Re-read report for errors or omissions while information is fresh Include the place and complete addresses of point of pickup and drop-off 10/15/

60 EMT/Paramedic Documentation Poor: Possible stroke Descriptive: Temporary LOC Numbness/tingling of arm, face, leg Facial drooping Slurred speech Loss of motor function one side of body 10/15/

61 EMT/Paramedic Documentation Poor: Required restraints Alzheimer s diagnosis (billed alone may not be payable; may need other reasons) Descriptive: Patient is violent Convulsing Harmful to self or others 10/15/

62 EMT/Paramedic Documentation Poor: Myocardial infarction (MI) Descriptive: Chest pain radiating to jaw, neck, arm Unexplained chest discomfort Nausea and vomiting Profuse sweating 10/15/

63 Clearer Documentation These explanations require further clarification and/or clearer documentation to support the need for ambulance transport: Patient cannot tolerate wheelchair BLS secondary to weakness Patient has pain 10/15/

64 Clearer Documentation (continued) Patient has dementia Patient forgetful Family requests ambulance transport Needs oxygen Needs monitoring 10/15/

65 Error: Medical Review Errors - Psychiatric Transport - Psychiatric transport does not have enough information to pay the claim Solution: Document within the trip report the reason an ambulance is required, such as suicide watch, needs restraint (with explanation of why), or overdose requiring continuous monitoring 10/15/

66 Error: Medical Review Errors - Level of Service - HCPCS for level of service billed incorrectly, examples: BLS vs ALS vs SCT Emergent vs Non-emergent Air vs Ground transport 10/15/

67 Solution: Medical Review Errors - Level of Service - Service level must reflect the level of care required to care for the patient at the time of transport Documentation must support level of service billed on claim 10/15/

68 Error: Medical Review Errors - Timeliness - ADR letters not returned within requested timeframe or not at all, thus the claim is denied without documentation 10/15/

69 Solution: Medical Review Errors - Timeliness - Providers have 30 days to submit ADR letter with an additional 15 day grace period to allow for mailing delays 10/15/

70 Error: Medical Review Errors - Mileage - Documenting fractional mileage inappropriately Mileage inconsistent throughout EMS report, trip sheets and the bill Billing miles beyond nearest facility as covered units 10/15/

71 Medical Review Errors - Mileage - Solution, per Internet Only Manual , Chapter 15, Section : Miles totaling less than 100 miles: Round up to the nearest tenth of a mile E.g miles will become 99.4 units Miles totaling less than 1 mile: Include a 0 before the decimal (e.g. 0.6) 10/15/

72 Solution: Medical Review Errors - Mileage - Miles totaling 100 miles or greater: Round up to the nearest whole number Trip miles or GPS can be used Document method 10/15/

73 Solution: Medical Review Errors - Mileage - Split mileage for miles beyond nearest facility Inappropriate miles to be billed with A0888 and use GY modifier on it, unless provider liable then leave GY off If mileage not supplied, Medicare automatically uses 0.1 unit as default Accurately document mileage throughout 10/15/

74 Determining Coverage The following details help Medical Review staff in determining the medical status and stability of the beneficiary at the time of transport: Vital signs, including oxygen saturation Glasgow coma scale Orientation status IV fluids infusing during transport Medications given/infusing during transport 10/15/

75 (continued) Determining Coverage Equipment used by the patient during transport (e.g. wound vac, ventilator, feeding tube, etc.) How did the patient get to/from the ambulance gurney Assessment (neuro status, respiratory status, etc.) 10/15/

76 Questions? Provider Contact Center Phone Numbers: JE: JF: /15/

77 Resources

78 Sign Up to Get Medicare News Now! Receive the most recent Noridian and CMS news and information s sent Tuesday/Friday Simple, quick sign up Regulation and policy updates Payment and reimbursement updates Workshop and educational event notices Noridian hours of availability and related notifications JE JF 10/15/

79 CMS Resources (This is not an all-inclusive list of available resources) Internet-Only Manuals (IOMs) IOM , Medicare Benefit Policy Manual (MBPM), Chapter 10 Ambulance Services IOM , Medicare Claims Processing Manual (MCPM), Chapter 15 Ambulance 10/15/

80 CMS Resources (This is not an all-inclusive list of available resources) Medicare Learning Network (MLN) Education/Learn/Get-Training/Get-trainingpage.html CMS Connects Provider enews National Provider Calls Announcements Events MLN Educational Products 10/15/

81 CMS Connects Provider enews 10/15/

82 CMS Resources (This is not an all-inclusive list of available resources) Ambulance Services Center Type/Ambulances-Services-Center.html Locate ambulance-specific links and other helpful links Online Ambulance Booklets Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports Medicare Ambulance Transports 10/15/

83 Noridian Resources (This is not an all-inclusive list of available resources) Noridian Website: JE Ambulance page: JF Ambulance page: _center/ambulance.html 10/15/

84 Other Resources (This is not an all-inclusive list of available resources) Healthcare Common Procedure Coding System (HCPCS) Manual Social Security Act (SSA) section 1862(a)(1)(A) Code of Federal Register section Coverage of Ambulance Services 10/15/

85 Thank you for attending today!

Medical Review Ambulance Presentation. Part B

Medical Review Ambulance Presentation. Part B Medical Review Ambulance Presentation Part B DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC (Noridian). It may be freely distributed in its entirety but may not

More information

Clinical Policy Guideline

Clinical Policy Guideline Policy Title: Ambulance Service Effective Date: 10/25/01 Clinical Policy Guideline Date Reviewed: 01/18/11, 03/19/14, 05/21/14, 07/29/2015 I. DEFINITION Ambulance service means a ground, sea or air vehicle

More information

10/9/2015. J6: Illinois State Ambulance Association. Today s Presenter. Disclaimer. J6 Provider Outreach and Education Consultant

10/9/2015. J6: Illinois State Ambulance Association. Today s Presenter. Disclaimer. J6 Provider Outreach and Education Consultant J6: Illinois State Ambulance Association October 2015 Add doc ctrl no. Today s Presenter J6 Provider Outreach and Education Consultant Carolyn S Henson CPC,CAC,CACO,CPC-I AAPC I-10 Instructor 2 Disclaimer

More information

Strategies for Each Payer Type. Medicare: Part 1. Medicare Coverage. Medicare. Medicare Requirements. Reimbursable Events

Strategies for Each Payer Type. Medicare: Part 1. Medicare Coverage. Medicare. Medicare Requirements. Reimbursable Events Strategies for Each Payer Type Medicare: Part 1 Medicare Medicaid Commercial Insurance Auto Insurance Private Pay Contracts Medicare Largest Payer for Ambulance Services Coverage Rules Fee Schedule Medicare

More information

AMBULANCE TRANSPORTATION GROUND

AMBULANCE TRANSPORTATION GROUND AMBULANCE TRANSPORTATION GROUND Policy NHP reimburses licensed ambulance providers for the provision of medically necessary ambulance ground transportation in a medical emergency for NHP members in accordance

More information

Clinical Medical Policy Ambulance Transportation. Benefit Coverage

Clinical Medical Policy Ambulance Transportation. Benefit Coverage Benefit Coverage A. Preface Transportation to medical appointments is a benefit for RIte Care, Sub Care, CSN, and RHP members. Members are expected to provide their own transportation to medical appointments;

More information

Clinical Medical Policy Ambulance Transportation

Clinical Medical Policy Ambulance Transportation The intent of this policy is to provide criteria to determine medical necessity for ambulance transportation when authorization is required. for Medicaid Products including: RIte Care, Substitute Care,

More information

Medical Coverage Policy Ambulance: Ground Transport

Medical Coverage Policy Ambulance: Ground Transport Medical Coverage Policy Ambulance: Ground Transport Device/Equipment Drug Medical Surgery Test Other Effective Date: 11/29/2001 Policy Last Updated: 6/19/2012 Prospective review is recommended/required.

More information

Copyright 2009, National Academy of Ambulance Coding Unauthorized copying/distribution is strictly prohibited

Copyright 2009, National Academy of Ambulance Coding Unauthorized copying/distribution is strictly prohibited Your instructor Levels of Service National Academy of Ambulance Coding Steve Wirth Founding Partner, Page, Wolfberg & Wirth LLC Over 30 years experience as an EMT, Paramedic, Flight Medic, EMS Instructor,

More information

TRANSPORTATION SERVICES

TRANSPORTATION SERVICES TRANSPORTATION SERVICES ADMINISTRATIVE POLICY Policy Number: TRANSPORT 002.15 T2 Effective Date: March 1, 2015 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS... COVERAGE RATIONALE...

More information

AMBULANCE SERVICES. Table of Contents

AMBULANCE SERVICES. Table of Contents AMBULANCE SERVICES Protocol: MSC023 Effective Date: 4/1/2015 Table of Contents Page COMMERCIAL COVERAGE RATIONALE... 1 MEDICARE & MEDICAID COVERAGE RATIONALE... 4 DEFINITIONS... 4 APPLICABLE CODES... 5

More information

Critical Care Billing and Coding. Date: February 2015 Presented by: Part B Provider Outreach & Education (POE)

Critical Care Billing and Coding. Date: February 2015 Presented by: Part B Provider Outreach & Education (POE) Critical Care Billing and Coding Date: February 2015 Presented by: Part B Provider Outreach & Education (POE) Workshop Protocol Cannot register with WebEx using mobile device Must use desktop or laptop

More information

Ambulance Services. Provider Manual

Ambulance Services. Provider Manual Provider Manual Provider 1 April 1, 2014 TABLE OF CONTENTS Chapter I. General Program Policies Chapter II. Member Eligibility Chapter IV. Billing Iowa Medicaid Appendix III. Provider-Specific Policies

More information

Ambulance Transportation A Partnership

Ambulance Transportation A Partnership Ambulance Transportation A Partnership DUH and JAS Duke University it Hospital uses Johnston Ambulance Service for a variety of patient transports. Wheelchair Van Services Basic Life Support Service (BLS)

More information

AMBULANCE SERVICES. Page

AMBULANCE SERVICES. Page AMBULANCE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CS003.C Effective Date: July 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS APPLICABLE CODES... REFERENCES... HISTORY/REVISION

More information

Medical Policy Original Effective Date: 02-28-2000 Revised Date: 01-27-16 Page 1 of 5. Ambulance Services MPM 1.1 Disclaimer.

Medical Policy Original Effective Date: 02-28-2000 Revised Date: 01-27-16 Page 1 of 5. Ambulance Services MPM 1.1 Disclaimer. Page 1 of 5 Ambulance Services Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all

More information

Medical Coverage Policy Ground Ambulance

Medical Coverage Policy Ground Ambulance Medical Coverage Policy Ground Ambulance Device/Equipment Drug Medical Surgery Test Other Effective Date: 11/29/2004 Policy Last Updated: 12/06/2011 Prospective review is recommended/required. Please check

More information

Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383)

Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383) Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID

More information

AMBULANCE SERVICES. Page

AMBULANCE SERVICES. Page AMBULANCE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CDG.001.03 Effective Date: June 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE CODES... REFERENCES... HISTORY/REVISION

More information

Local Coverage Determination (LCD): Ambulance Services (L34549)

Local Coverage Determination (LCD): Ambulance Services (L34549) Local Coverage Determination (LCD): Ambulance Services (L34549) Contractor Name Palmetto GBA Document Information LCD ID L34549 LCD Title Ambulance Services Original Effective Date For services performed

More information

Tennessee Ambulance Services Association Conference

Tennessee Ambulance Services Association Conference Tennessee Ambulance Services Association Conference Nashville, TN October 7, 2014 Clinical Education Presented by Julia McKinley, RN, MAED Provider Outreach and Education Disclaimers This resource is not

More information

Medicare Ambulance Services

Medicare Ambulance Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Official CMS Information for Medicare Fee-For-Service Providers Medicare Ambulance Services ICN 903194 May 2011 This publication

More information

Transitional Care Management (TCM) Presented by Noridian Part B Medicare Provider Outreach and Education May 2016

Transitional Care Management (TCM) Presented by Noridian Part B Medicare Provider Outreach and Education May 2016 Transitional Care Management (TCM) Presented by Noridian Part B Medicare Provider Outreach and Education DISCLAIMER This information release is the property of Noridian Administrative Services, LLC (NAS).

More information

Local Coverage Determination (LCD): Transportation Services: Ambulance (L34302)

Local Coverage Determination (LCD): Transportation Services: Ambulance (L34302) Local Coverage Determination (LCD): Transportation Services: Ambulance (L34302) Contractor Information Contractor Name Cahaba Government Benefit Administrators, LLC LCD Information Document Information

More information

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014 Medicare 101: Basics of Modifier Billing Part B Provider Outreach and Education February 26, 2014 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345

More information

PA.203.MH Non-Emergent Ambulance Transportation

PA.203.MH Non-Emergent Ambulance Transportation MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.203.MH Non-Emergent Ambulance Transportation This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar

More information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY Original Issue Date (Created): 7/1/2002 Most Recent Review Date (Revised): 1/27/2015 Effective Date: 6/1/2015 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Medicare Ambulance Transports

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Medicare Ambulance Transports DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Ambulance Transports ICN 903194 June 2014 This booklet was current at the time it was published or uploaded onto

More information

Effective Ambulance Service Auditing: A Suggested Approach

Effective Ambulance Service Auditing: A Suggested Approach Feature Effective Ambulance Service Auditing: A Suggested Approach By R. Michael Scarano, Jr. Executive Summary Because the Medicare rules governing ambulance services are complex and unique, providers

More information

Intermediaries/Carriers

Intermediaries/Carriers Department of Health and Program Memorandum Human Services (DHHS) Intermediaries/Carriers CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) Transmittal AB-01-165 Date: NOVEMBER 14, 2001 CHANGE REQUEST 1555

More information

Chapter. CPT only copyright 2015 American Medical Association. All rights reserved. 9 Ambulance

Chapter. CPT only copyright 2015 American Medical Association. All rights reserved. 9 Ambulance 9 Ambulance Chapter 9 9.1 Enrollment........................................................................ 9-2 9.2 General Information............................................................... 9-2

More information

BULLETIN. Medical. Assis. Programs. ssistance. AMBULANCE PROVIDER Policy and Procedure Update ELIMINATION OF LOCAL CODES

BULLETIN. Medical. Assis. Programs. ssistance. AMBULANCE PROVIDER Policy and Procedure Update ELIMINATION OF LOCAL CODES July 2003 Kansas Medical Assis ssistance Programs AMBULANCE PROVIDER Policy and Procedure Update ELIMINATION OF LOCAL CODES BULLETIN Effective with dates of service on and after July 14, 2003, all Ambulance

More information

Chronic Care Management (CCM) Services. Presented by Noridian Part B Medicare Provider Outreach and Education December 2015

Chronic Care Management (CCM) Services. Presented by Noridian Part B Medicare Provider Outreach and Education December 2015 Chronic Care Management (CCM) Services Presented by Noridian Part B Medicare Provider Outreach and Education December 2015 DISCLAIMER This information release is the property of Noridian Healthcare Solutions,

More information

At Elite Ambulance, we are always here to serve you.

At Elite Ambulance, we are always here to serve you. FAQ Important Disclaimer: The following FAQ section includes information regarding health provider decisions, health and payment matters not financial matters. None of the following questions or answers

More information

Final Adoption 6/26/08 114.3 CMR 27.00: AMBULANCE SERVICES. Section

Final Adoption 6/26/08 114.3 CMR 27.00: AMBULANCE SERVICES. Section 114.3 CMR 27.00: AMBULANCE SERVICES Section 27.01: General Provisions 27.02: General Definitions 27.03: General Rate Provisions and Maximum Fees 27.04: Filing and Reporting Requirements 27.05: Severability

More information

Non-Emergency Non-Ambulance Services - TRANSCITA

Non-Emergency Non-Ambulance Services - TRANSCITA Non-Emergency Non-Ambulance Services - TRANSCITA [Preauthorization Required] Medical Policy: MP-TRANS-01-11 Original Effective Date: March 24, 2011 Reviewed: Revised: This policy applies to products subscribed

More information

Ambulance Services. Medicaid and Other Medical Assistance Programs

Ambulance Services. Medicaid and Other Medical Assistance Programs Ambulance Services Medicaid and Other Medical Assistance Programs March 2015 This publication supersedes all previous Ambulance Services manuals. Published by the Department of Health and Human Services,

More information

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Ambulance

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Ambulance KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Ambulance PART II Introduction Section BILLING INSTRUCTIONS Page 7000 Ambulance Billing Instructions............... 7-1 Submission of Claim..................

More information

(d) Ambulance services means advanced life support services or basic life support services.

(d) Ambulance services means advanced life support services or basic life support services. Initial Proposal DRAFT 6/21/12 1 Readopt with amendment He-W 572, effective 5/30/06 (Document #8638), as amended effective 7/1/12 (Document #10139), to read as follows:] PART He-W 572 AMBULANCE SERVICES

More information

Ambulance Basics Part B Coverage Guidelines. Presented by: Medicare Part B Provider Outreach and Education (POE) November 2015

Ambulance Basics Part B Coverage Guidelines. Presented by: Medicare Part B Provider Outreach and Education (POE) November 2015 Ambulance Basics Part B Coverage Guidelines Presented by: Medicare Part B Provider Outreach and Education (POE) November 2015 DISCLAIMER This information release is the property of Noridian Healthcare

More information

How Do I Ask Questions During this Webinar? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida.

How Do I Ask Questions During this Webinar? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida. 1 How Do I Ask Questions During this Webinar? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida.com 2 Training Objectives Provide an overview of the Florida Medicaid

More information

Telehealth Services. Part B Provider Outreach and Education January 2016

Telehealth Services. Part B Provider Outreach and Education January 2016 Telehealth Services Part B Provider Outreach and Education January 2016 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety

More information

Subject: Transportation Services: Ambulance and Non-Emergent Transport

Subject: Transportation Services: Ambulance and Non-Emergent Transport Reimbursement Policy Subject: Transportation Services: Ambulance and Non-Emergent Transport Effective Date: 01/01/15 Committee Approval Obtained: 01/01/15 Section: Transportation ***** The most current

More information

Chapter 27 Non-Emergency Medical Transportation Services

Chapter 27 Non-Emergency Medical Transportation Services Chapter 27 Non-Emergency Medical Transportation Services Overview This chapter provides information on South Country Health Alliance s (SCHA) coverage for Transportation Services. Definitions Access Transportation

More information

Local Coverage Determination (LCD) for Transportation Services: Ambulance (L30022)

Local Coverage Determination (LCD) for Transportation Services: Ambulance (L30022) Local Coverage Determination (LCD) for Transportation Services: Ambulance (L30022) Contractor Information Contractor Name Cahaba Government Benefit Administrators, LLC Back to Top LCD Information Document

More information

Medicare Secondary Payer Calculations Presented by: Provider Outreach and Education (POE) September 2015

Medicare Secondary Payer Calculations Presented by: Provider Outreach and Education (POE) September 2015 Medicare Secondary Payer Calculations Presented by: Provider Outreach and Education (POE) DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC (Noridian). It may be

More information

1. Transportation Services

1. Transportation Services Table of Contents 1.... 1 1.1. Introduction... 1 1.1.1. Non-Emergency Record Keeping Requirements... 1 1.2. Ambulance... 1 1.3. Non-Emergent Transportation (NET)... 1 1.3.1. Freedom of Choice... 1 1.3.2.

More information

Subject: Transportation Services: Ambulance and Nonemergent Transport

Subject: Transportation Services: Ambulance and Nonemergent Transport UniCare Health Plan of West Virginia, Inc. Medicaid Managed Care Reimbursement Policy Subject: Transportation Services: Ambulance and Nonemergent Transport Effective Date: 03/01/15 Committee Approval Obtained:

More information

When you document an incident, you are writing for several different audiences. There s the legal audience the number of records requests we receive

When you document an incident, you are writing for several different audiences. There s the legal audience the number of records requests we receive 1 When you document an incident, you are writing for several different audiences. There s the legal audience the number of records requests we receive from attorneys continues to grow. There s the patient

More information

Florida Medicaid AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS HANDBOOK

Florida Medicaid AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS HANDBOOK Florida Medicaid AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration August 2013 UPDATE LOG AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS

More information

FEE-FOR-SERVICE PROVIDER MANUAL CHAPTER 14 TRANSPORTATION

FEE-FOR-SERVICE PROVIDER MANUAL CHAPTER 14 TRANSPORTATION REVISION DATES: 01/28/2015 clarification 14-10, 14-11, 08/28/2014, 04/17/2014, 03/18/2014, 12/11/2013 Emergency Transportation Services AHCCCS covers emergency ground and air ambulance transportation services,

More information

P o l i c y C h a n g e s

P o l i c y C h a n g e s Wyoming Department Of Health Medicaid EqualityCare Ambulance Services 01-001 Effective January 1, 2001, the 2001 ambulance HCPCS codes went into effect and have been accepted by Wyoming Medicaid since

More information

AIR AMBULANCE SERVICES

AIR AMBULANCE SERVICES Protocol: OTH019 Effective Date: April 11, 2012 AIR AMBULANCE SERVICES Table of Contents Page COMMERCIAL, MEDICARE & MEDICAID COVERAGE RATIONALE... 1 BACKGROUND... 7 APPLICABLE CODES... 7 REFERENCES...

More information

Chapter 27 Non-Emergency Transportation Services

Chapter 27 Non-Emergency Transportation Services Chapter 27 Non-Emergency Transportation Services Overview This chapter provides information on South Country Health Alliance s (SCHA) coverage for Transportation Services. Definitions Access Transportation

More information

Reimbursement Policy. Subject: Transportation Services: Ambulance and Nonemergent Transport. Policy

Reimbursement Policy. Subject: Transportation Services: Ambulance and Nonemergent Transport. Policy Reimbursement Policy Subject: Transportation Services: Ambulance and Nonemergent Transport Effective Date: 12/06/10 Committee Approval Obtained: 08/18/14 Section: Transportation *****The most current version

More information

Ambulance Policy. November 2007! No. 2007-75. Clarification of Wisconsin Medicaid Policy. Documentation Requirements

Ambulance Policy. November 2007! No. 2007-75. Clarification of Wisconsin Medicaid Policy. Documentation Requirements November 2007! No. 2007-75 To: Ambulance Providers HMOs and Other Managed Care Programs Ambulance Policy This Wisconsin Medicaid and BadgerCare Update clarifies existing policies and announces new Wisconsin

More information

Medicare Benefit Policy Manual Chapter 10 - Ambulance Services

Medicare Benefit Policy Manual Chapter 10 - Ambulance Services Medicare Benefit Policy Manual Chapter 10 - Ambulance Services Transmittals for Chapter 10 10 - Ambulance Service Table of Contents (Rev. 187, 05-01-14) (Rev. 190, 07-11-14) 10.1 - Vehicle and Crew Requirement

More information

Provider Handbooks. Ambulance Services Handbook

Provider Handbooks. Ambulance Services Handbook Volume 2 Provider Handbooks Ambulance Services Handbook This manual is available for download at www.tmhp.com, and is also available on CD. There are many benefits to using the electronic manual, including

More information

PROTOCOLS FOR NON-EMERGENCY MEDICAL TRANSPORTATION PROVIDERS

PROTOCOLS FOR NON-EMERGENCY MEDICAL TRANSPORTATION PROVIDERS PROTOCOLS FOR NON-EMERGENCY MEDICAL TRANSPORTATION PROVIDERS CenCal Health members may access Non-Emergency Medical Transportation services when the member does not require emergency services or equipment

More information

Chapter 16. Medicaid Provider Manual

Chapter 16. Medicaid Provider Manual Chapter 16 Medicaid Provider Manual CHAPTER 16 Date Revised: TABLE OF CONTENTS 16.1 Emergency/Ambulance Services... 1 16.2 Non-Emergency Ground Transportation... 2 16.2.1 Taxi Services... 2 16.2.2 Curb-to-Curb

More information

Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy

Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy File name: Ambulance and Medical Transport Services (Ground, Air and Water) File code: UM.SPSVC.06 Origination:

More information

Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports

Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports ICN 909008 August 2014

More information

206 Capitol Street -3 rd Flr Charleston, WV 25301 P. 304-544-9733 chris@wvemscoalition.com

206 Capitol Street -3 rd Flr Charleston, WV 25301 P. 304-544-9733 chris@wvemscoalition.com July 24, 2015 WV Bureau for Medical Services Transportation 350 Capitol Street, Room 251 Charleston, WV 25301 BMS.comments@wv.gov RE: Transportation, Chapter 524, and appendix To Whom It May Concern: The

More information

Reciprocal Billing and Locum Tenens. Presented by: Medicare Part B Provider Outreach and Education (POE) May 2016

Reciprocal Billing and Locum Tenens. Presented by: Medicare Part B Provider Outreach and Education (POE) May 2016 Reciprocal Billing and Locum Tenens Presented by: Medicare Part B Provider Outreach and Education (POE) May 2016 Disclaimer This information release is the property of Noridian Healthcare Solutions, LLC

More information

205 GROUND AMBULANCE TRANSPORTATION REIMBURSEMENT GUIDELINES FOR NON-CONTRACTED PROVIDERS

205 GROUND AMBULANCE TRANSPORTATION REIMBURSEMENT GUIDELINES FOR NON-CONTRACTED PROVIDERS 205 GROUND AMBULANCE TRANSPORTATION REIMBURSEMENT GUIDELINES FOR NON-CONTRACTED PROVIDERS EFFECTIVE DATE: 05/01/2006, 04/01/2013 REVISION DATE: 04/04/2013 STAFF RESPONSIBLE FOR POLICY: DHCM ADMINISTRATION

More information

Chapter 1 Section 14

Chapter 1 Section 14 General Chapter 1 Section 14 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(d)(3)(v), 32 CFR 199.14(j)(1)(i)(A), and 10 USC 1079(h)(1) 1.0 APPLICABILITY This policy is mandatory for reimbursement

More information

Long Term Care Hospitals (LTCH) Part A Provider Outreach & Education January 2015

Long Term Care Hospitals (LTCH) Part A Provider Outreach & Education January 2015 Long Term Care Hospitals (LTCH) Part A Provider Outreach & Education January 2015 Workshop Protocol Cannot register with WebEx using mobile device Must use desktop or laptop When entering/throughout workshop

More information

PART B MEDICARE. Ambulance Billing Guide June 2011. NHIC, Corp. RT B. REF-EDO-0004 Version 4.0

PART B MEDICARE. Ambulance Billing Guide June 2011. NHIC, Corp. RT B. REF-EDO-0004 Version 4.0 MEDICARE PART B RT B Ambulance Billing Guide June 2011 NHIC, Corp. NHIC, Corp. 2 June 2011 Table of Contents Introduction... 6 The Medicare Part B Ambulance Benefit... 7 Coverage criteria... 7 Vehicle

More information

Chapter. CPT only copyright 2008 American Medical Association. All rights reserved. 9Ambulance

Chapter. CPT only copyright 2008 American Medical Association. All rights reserved. 9Ambulance Chapter 9Ambulance 9 9.1 Enrollment........................................................ 9-2 9.2 Emergency Ground Ambulance Transportation.............................. 9-2 9.2.1 Benefits, Limitations,

More information

Provider Handbooks. Ambulance Services Handbook

Provider Handbooks. Ambulance Services Handbook Provider Handbooks October 2015 Ambulance Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human

More information

Competitive Acquisition Program (CAP) for Part B Drugs & Biologicals Training for Supplemental Insurance Companies August 2007

Competitive Acquisition Program (CAP) for Part B Drugs & Biologicals Training for Supplemental Insurance Companies August 2007 Competitive Acquisition Program (CAP) for Part B Drugs & Biologicals Training for Supplemental Insurance Companies August 2007 DISCLAIMER This information release is the property of Noridian Administrative

More information

Complimentary Wi-Fi is available: Connect to HYATT-MEETING or MEYDENBAUER WELCOMES PNDC. Use Password: PNDC2015.

Complimentary Wi-Fi is available: Connect to HYATT-MEETING or MEYDENBAUER WELCOMES PNDC. Use Password: PNDC2015. Welcome to the Pacific Northwest Dental Conference! To provide quality continuing dental education programs that will promote the highest standards of patient care and professionalism in the dental community.

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENTAL APPEALS BOARD

DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENTAL APPEALS BOARD DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENTAL APPEALS BOARD ORDER OF MEDICARE APPEALS COUNCIL REMANDING CASE TO ADMINISTRATIVE LAW JUDGE Docket Number: M-11-2222 In the case of Eagle Air Medical

More information

Section. CPT only copyright 2007 American Medical Association. All rights reserved. 8Ambulance

Section. CPT only copyright 2007 American Medical Association. All rights reserved. 8Ambulance Section 8Ambulance 8 8.1 Enrollment........................................................ 8-2 8.1.1 Medicaid Managed Care Enrollment................................. 8-2 8.2 Reimbursement....................................................

More information

Intermediaries/Carriers

Intermediaries/Carriers Department of Health and Program Memorandum Human Services (DHHS) Intermediaries/Carriers HEALTH CARE FINANCING ADMINISTRATION (HCFA) Transmittal AB-00-88 Date: SEPTEMBER 18, 2000 CHANGE REQUEST 1281 THE

More information

Fraud and Abuse Emergency Medical Services and Ambulance Services

Fraud and Abuse Emergency Medical Services and Ambulance Services Fraud and Abuse Emergency Medical Services and Ambulance Services William C. Krasner JD,MBA,RN,EMT,CHC What I Will Share Overview of Emergency Medical Services The Problem OIG Compliance Guide Coverage

More information

Origin Destination Medicare Covers. Home Nursing Home or Hospital Yes. Hospital Home or Nursing Home Yes

Origin Destination Medicare Covers. Home Nursing Home or Hospital Yes. Hospital Home or Nursing Home Yes Billing Requirements For All Transports Definitions: A. Medically Necessary This means that the service given is in the best interest of the patient s health. For ambulance transports, this means that

More information

Chapter. CPT only copyright 2009 American Medical Association. All rights reserved. 9Ambulance

Chapter. CPT only copyright 2009 American Medical Association. All rights reserved. 9Ambulance Chapter 9Ambulance 9 9.1 Enrollment........................................................ 9-2 9.2 Emergency Ground Ambulance Transportation.............................. 9-2 9.2.1 Benefits, Limitations,

More information

GAO AMBULANCE SERVICES. Changes Needed to Improve Medicare Payment Policies and Coverage Decisions. Testimony

GAO AMBULANCE SERVICES. Changes Needed to Improve Medicare Payment Policies and Coverage Decisions. Testimony GAO United States General Accounting Office Testimony Before the Committee on Governmental Affairs, U.S. Senate For Release on Delivery Expected at 9:15 a.m. Thursday, November 15, 2001 AMBULANCE SERVICES

More information

WYOMING MEDICAID RULES CHAPTER 15 AMBULANCE SERVICES

WYOMING MEDICAID RULES CHAPTER 15 AMBULANCE SERVICES WYOMING MEDICAID RULES CHAPTER 15 AMBULANCE SERVICES Section 1. Authority These rules are promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W.S. 42-4-101 et

More information

WHO. Certified Ambulance Coder? Are you a. Certified Ambulance Coders pave the road to compliance. WHO should become a Certified Ambulance Coder?

WHO. Certified Ambulance Coder? Are you a. Certified Ambulance Coders pave the road to compliance. WHO should become a Certified Ambulance Coder? CAC certification is also recommended for billing office supervisors and managers, compliance officers, QA coordinators, and upper level management in an ambulance service, billing company or any other

More information

NON-EMERGENCY MEDICAL TRANSPORTATION

NON-EMERGENCY MEDICAL TRANSPORTATION NON-EMERGENCY MEDICAL TRANSPORTATION Brief Coverage Statement Non-Emergency Medical Transportation (NEMT) is provided as an administrative service for Colorado Medical Assistance Program (Colorado Medicaid)

More information

Ch. 1245 AMBULANCE TRANSPORTATION 55 CHAPTER 1245. AMBULANCE TRANSPORTATION GENERAL PROVISIONS COVERED AND NONCOVERED SERVICES SCOPE OF BENEFITS

Ch. 1245 AMBULANCE TRANSPORTATION 55 CHAPTER 1245. AMBULANCE TRANSPORTATION GENERAL PROVISIONS COVERED AND NONCOVERED SERVICES SCOPE OF BENEFITS Ch. 1245 AMBULANCE TRANSPORTATION 55 CHAPTER 1245. AMBULANCE TRANSPORTATION Sec. 1245.1. Policy. 1245.2. Definitions. GENERAL PROVISIONS COVERED AND NONCOVERED SERVICES 1245.11. Types of services covered.

More information

Basic Medical Record Documentation

Basic Medical Record Documentation Basic Medical Record Documentation Presented by Cahaba Government Benefit Administrators, LLC P rovider O u t reach and Education September 19, 2013 1 Disclaimers This resource is not a legal document.

More information

Medical Transportation- Making Sense of the Ambulance Compliance Conundrum

Medical Transportation- Making Sense of the Ambulance Compliance Conundrum - Making Sense of the Ambulance Compliance Conundrum Marc Goldstone, Esq., MICP Partner Hoagland, Longo, Moran, Dunst & Doukas, LLP 40 Paterson Street, P.O. Box 480 New Brunswick, NJ 08903 732-545- 4717

More information

Revision to the Medical Assistance Health Programs Office Rule Concerning Emergency Medical Transportation Services, Section 8.018

Revision to the Medical Assistance Health Programs Office Rule Concerning Emergency Medical Transportation Services, Section 8.018 Title of Rule: Rule Number: Division / Contact / Phone: Revision to the Medical Assistance Health Programs Office Rule Concerning Emergency Medical Transportation Services, Section 8.018 MSB 14-10-02-A

More information

Medicare Program; Expansion of Prior Authorization for Repetitive Scheduled

Medicare Program; Expansion of Prior Authorization for Repetitive Scheduled This document is scheduled to be published in the Federal Register on 10/23/2015 and available online at http://federalregister.gov/a/2015-27030, and on FDsys.gov DEPARTMENT OF HEALTH AND HUMAN SERVICES

More information

Allow us to show you and your clients the new standard in medical transport.

Allow us to show you and your clients the new standard in medical transport. Off Duty Firefighter Medical Transport 411 Merritt St Grand Prairie, Texas 75052 214-243-8703 www.odfmedicaltransport.org Email: odfmedicaltransport@yahoo.com Mission Statement: Off Duty Firefighter Medical

More information

Certifying Patients for the Medicare Home Health Benefit

Certifying Patients for the Medicare Home Health Benefit Certifying Patients for the Medicare Home Health Benefit Hillary Loeffler, Technical Advisor Dr. Crystal Simpson, Medical Officer Center for Medicare, Chronic Care Policy Group Effective as of January

More information

Federally Qualified Health Center Billing and Coverage

Federally Qualified Health Center Billing and Coverage Federally Qualified Health Center Billing and Coverage May 1, 2014 Today s Presenter Mimi Vier, CPC Provider Outreach and Education Consultant 2 Disclaimer National Government Services, Inc. has produced

More information

SUBSCRIPTION TERMS AND CONDITIONS

SUBSCRIPTION TERMS AND CONDITIONS SUBSCRIPTION TERMS AND CONDITIONS Subscribers of Jefferson Hills Area Ambulance Association hereinafter referred to as JHAAA, receive the benefit of unlimited access to basic and advanced life support

More information

REVIEW OF MEDICARE CLAIMS FOR AIR AMBULANCE SERVICES PAID TO NATIVE AMERICAN AIR AMBULANCE

REVIEW OF MEDICARE CLAIMS FOR AIR AMBULANCE SERVICES PAID TO NATIVE AMERICAN AIR AMBULANCE Department of Health and Human Services OFFICE OF INSPECTOR GENERAL REVIEW OF MEDICARE CLAIMS FOR AIR AMBULANCE SERVICES PAID TO NATIVE AMERICAN AIR AMBULANCE Daniel R. Levinson Inspector General JULY

More information

Medicare Coverage of Ambulance Services

Medicare Coverage of Ambulance Services CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare Coverage of Ambulance Services This official government booklet explains the following: When Medicare helps cover ambulance services What Medicare pays

More information

Federally Qualified Health Centers (FQHC) Billing 1163_0212

Federally Qualified Health Centers (FQHC) Billing 1163_0212 Federally Qualified Health Centers (FQHC) Billing 1163_0212 Today s Presenter Charles Wiley- Provider Outreach and Education Representative 2 Disclaimer has produced this material as an informational reference

More information

Clarification of Patient Discharge Status Codes and Hospital Transfer Policies

Clarification of Patient Discharge Status Codes and Hospital Transfer Policies The Acute Inpatient Prospective Payment System Fact Sheet (revised November 2007), which provides general information about the Acute Inpatient Prospective Payment System (IPPS) and how IPPS rates are

More information

Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers

Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers The following questions and answers are from the April 2012 CAH and CAH Swingbed web-based trainings: Q1. Is a non-covered/no pay bill

More information

Ambulance Services Clinical Coverage Policy No: 15 Effective Date: February 1, 2016. Table of Contents

Ambulance Services Clinical Coverage Policy No: 15 Effective Date: February 1, 2016. Table of Contents Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 1.1.1 Ground and Air Medical Ambulances... 1 1.1.2 Emergency Services... 1 1.1.2.1 Emergency Medical Condition...

More information

Provider Handbooks. Ambulance Services Handbook

Provider Handbooks. Ambulance Services Handbook Provider Handbooks November 2015 Ambulance Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human

More information