February 17th, 2009
The stimulus bill, which is likely to be signed into Law by President Obama will place more stringent guidelines on ambulance providers and covered business associates of ambulance companies including billing services, clearinghouses, and other holders of protected health information (PHI). See this article from Page Wolfberg and Worth regarding these changes.
Please also see the full text of what has been proposed in the American Recovery and Reinvestment Act of 2009 by clicking here.
Tags: American Recovery and Reinvestment Act of 2009, Federal Register, HIPAA, Obama, PHI, PWW
Posted in ABC Update, Federal Register | No Comments »
February 13th, 2009
ABC will be hosting an exciting event in West Point next Friday, February 20, 2009. There will be presentations from premier software and hardware companies pertaining to helping your department go paperless with success. Online PCR data entry is the future of EMS patient care reporting. Access and enter PCRs from any computer. Manage and QA calls from any computer and much, much more.
We will be discussing field data, Medicare laws and regulations, and other EMS billing topics. Contact us today if you are interested in attending.
Tags: ambulance billing, ems billing, field data software, medicare laws
Posted in Welcome | No Comments »
January 27th, 2009
This is exciting news from Cahaba GBA.
Internet-Based Medicare Enrollment Is NOW Available
Internet-Based Medicare Enrollment is now available for Medicare Physicians and Non-Physician Practitioners (All States and the District of Columbia).
It’s Fast, Secure, and Easy!
Now there’s a better way for physicians and non-physician practitioners to enroll or make a change in their Medicare enrollment information. The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow physicians and non-physician practitioners to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check on the status of a Medicare enrollment application via the Internet.
The Centers for Medicare & Medicaid Services (CMS) will make Internet-based PECOS to all organizational providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers) later this year.
Fast
By submitting the initial Medicare enrollment application through Internet-based PECOS, a physician or non-physician practitioner’s enrollment application can be processed as much as 50 percent faster than by paper. This means that it will take less time to enroll or make a change in an existing enrollment record. For additional information about the types of changes that must be reported, go to the download section of www.cms.hhs.gov/MedicareProviderSupEnroll.
Secure
Internet-based PECOS meets all required Government security standards in terms of data entry, data transmission, and the electronic storage of Medicare enrollment information. Only authorized individuals can enter enrollment information into PECOS or view PECOS data from the Internet. Authorized individuals include physicians and non-physician practitioners. Their User IDs and passwords protect the access to their enrollment information. After physicians or non-physician practitioners create User IDs and passwords or change their passwords, they should keep this information secure and not share it with anyone. By safeguarding their User IDs and passwords, they are taking an important step in protecting their enrollment information. CMS does not disclose Medicare enrollment information to anyone except when we are authorized or required to do so by law.
Easy
Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process will ensure that physicians and non-physician practitioners complete and submit only the information necessary to enroll or make a change in their Medicare enrollment record.
There are three basic steps to completing an enrollment action using Internet-based PECOS. Physicians and non-physician practitioners must:
1. Have an NPPES User ID and password to use Internet-based PECOS.
• For security reasons, physicians and non-physician practitioners should change passwords periodically, at least once a year. For information on how to change a password, go to the NPPES Application Help page available at https://nppes.cms.hhs.gov/NPPES/Welcome.do and select the “Reset Password Page” under the NPPES Application help page.
2. Go to Internet-based PECOS at https://pecos.cms.hhs.gov and complete, review, and submit the electronic enrollment application via Internet-based PECOS.
3. Print, sign and date the Certification Statement (blue ink recommended) and mail the Certification Statement and all supporting paper documentation to the Medicare contractor.
Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated Certification Statement and the required supporting documentation. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed Certification Statement that is associated with the Internet submission.
Additional Information
For information about Internet-Based PECOS, including important information that physicians and non-physician practitioners should know before submitting a Medicare enrollment application via Internet-based PECOS, go to www.cms.hhs.gov/MedicareProviderSupEnroll.
Tags: ambulance billing, ems billing, Medicare, Medicare Provider Enrollment
Posted in Cahaba, Georgia | No Comments »
January 26th, 2009
This great information is provided by our friends at Brock Clay:
CALENDAR
The General Assembly was not in session this week. Instead, the House and Senate Appropriations Committees met in joint hearings to hear from state agencies on their proposed budgets from the governor.
BUDGET & MEDICAID
On Friday, The Department of Community Health (DCH) and the Department of Human Resources (DHR) presented their FY 2009 Amended Budget and their FY 2010 Budget to a joint meeting of the House and Senate Appropriations Meetings.
DHR received many questions from legislators on the potential costs associated with the Division of Public Health being moved to DCH. DHR was not able to provide any details and the governor’s office insists that any re-structuring will be revenue neutral.
The 1.6% taxes on health insurance providers and hospitals was the item that received the most discussion during DCH’s presentation. DCH is still debating on how to assess such a tax on hospitals (whether it will be on total patient revenue, on the number of beds, or another method).
DCH also informed legislators that the governor’s office is still working on the legislation that is required to implement these new taxes. One potential problem already developing is that some legislators are already discussing possible exemptions of certain hospitals from the new taxes.
Some of the most influential legislative leaders are insisting that they are not going to implement these new taxes and another source of revenue or cuts will be needed. These same legislators also insist that raising the tax on tobacco related products is not an option.
The governor’s office has said that the governor would reconsider these new fees if a stimulus package from the federal government included funds for Medicaid.
NEW LEGISLATION
HB 19 – creating penalties for using a cell phone while driving
HB 23 – outlaws using a cell phone or text messaging if you are under 18
HB 105 – allows emergency 9-1-1 systems to direct non-emergency calls for public safety agencies.
HB 31 – repealing the law allowing red light cameras
SB 5 – requires seat belts in pickup trucks
Tags: Brock Clay, GAEMS, Georgia EMS, Georgia Medicaid
Posted in Georgia | No Comments »
January 26th, 2009
This is an update from Medicare’s Medlearn Matters email update: Link
This Special Edition article describes SNF Consolidated Billing (CB) as it applies to ambulance services for SNF residents.
Clarification:
The SNF CB requirement makes the SNF responsible for including on the Part A bill that it submits to its Medicare intermediary almost all of the services that a resident receives during the course of a Medicare-covered stay, except for a small number of services that are specifically excluded from this provision. These “excluded” services can be separately furnished to the resident and billed under Medicare Part B by a variety of outside sources. These sources can include other providers of service (such as hospitals), which would submit the bill for Part B services to their Medicare intermediary, as well as practitioners and suppliers who would generally submit their bills to a Medicare Part B carrier. (Bills for certain types of items or equipment would be submitted by the supplier to their Durable Medical Equipment Medicare Administrative Contractor (DME MAC).
When the SNF Prospective Payment System (PPS) was introduced in 1998, it changed not only the way SNFs are paid but also the way SNFs must work with suppliers, physicians, and other practitioners. CB assigns the SNF the Medicare billing responsibility for virtually all of the services that the SNF residents receive during the course of a covered Part A stay. Payment for this full range of service is included in the SNF PPS global per diem rate.
The only exceptions are those services that are specifically excluded from this provision, which remain separately billable to Medicare Part B by the entity that actually furnished the service. See MLN Matters Edition SE0431 for a detailed overview of SNF CB, including a section on services excluded from SNF CB. This instruction can be found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0431.pdf on the CMS website.
Ambulance services have not been identified as a type of service that is categorically excluded from the CB provisions. However, certain types of ambulance transportation have been identified as being separately billable in specific situations, i.e. based on the reason the ambulance service is needed. This policy is comparable to the one governing ambulance services furnished in the inpatient hospital setting, which has been subject to a similar comprehensive Medicare billing or “bundling” requirement since 1983. Since the law describes CB in terms of services that are furnished to a “resident” of a SNF, the initial ambulance trip that brings a beneficiary to a SNF is not subject to CB, as the beneficiary has not yet been admitted to the SNF as a resident at that point.
Similarly, an ambulance trip that conveys a beneficiary from the SNF at the end of a stay is not subject to CB when it occurs in connection with one of the events specified in regulations at 42 CFR 411.15(p)(3)(i)-(iv) as ending the beneficiary’s SNF “resident” status. The events are as follows:
- A trip for an inpatient admission to a Medicare-participating hospital or critical access hospital (CAH) (See discussion below regarding an ambulance trip made for the purpose of transferring a beneficiary from the discharging SNF to an inpatient admission at another SNF.);
- A trip to the beneficiary’s home to receive services from a Medicare-participating home health agency under a plan of care;
- A trip to a Medicare-participating hospital or CAH for the specific purpose of receiving emergency services or certain other intensive outpatient services that are not included in the SNF’s comprehensive care plan (see further explanation below); or
- A formal discharge (or other departure) from the SNF that is not followed by readmission to that or another SNF by midnight of that same day.
Ambulance Trips to Receive Excluded Outpatient Hospital Services The regulations specify the receipt of certain exceptionally intensive or emergency services furnished during an outpatient visit to a hospital as one circumstance that ends a beneficiary’s status as an SNF resident for CB purposes. Such outpatient hospital services are, themselves, excluded from the CB requirement, on the basis that they are well beyond the typical scope of the SNF care plan. Currently, only those categories of outpatient hospital services that are specifically identified in Program Memorandum (PM) No. A-98-37, November 1998 (reissued as PM No. A-00-01, January 2000) are excluded from CB on this basis. These services are the following:
- Cardiac catheterization;
- Computerized Axial Tomography Imaging (CT) scans;
- Magnetic Resonance Imaging (MRI) services;
- Ambulatory surgery involving the use of an operating room (the ambulatory surgical exclusion includes the insertion of percutaneous esophageal gastrostomy (PEG) tubes in a gastrointestinal or endoscopy suite);
- Emergency room services;
- Radiation therapy;
- Angiography; and
- Lymphatic and venous procedures.
Since a beneficiary’s departure from the SNF to receive one of these excluded types of outpatient hospital services is considered to end the beneficiary’s status as an SNF resident for CB purposes with respect to those services, any associated ambulance trips are, themselves, excluded from CB as well. Therefore, an ambulance trip from the SNF to the hospital for the receipt of such services should be billed separately under Part B by the outside supplier. Moreover, once the beneficiary’s SNF resident status has ended in this situation, it does not resume until the point at which the beneficiary actually arrives back at the SNF; accordingly, the return ambulance trip from the hospital to the SNF would also be excluded from CB.
Other Ambulance Trips
By contrast, when a beneficiary leaves the SNF to receive offsite services other than the excluded types of outpatient hospital services described above and then returns to the SNF, he or she retains the status of a SNF resident with respect to the services furnished during the absence from the SNF. Accordingly, ambulance services furnished in connection with such an outpatient visit would remain subject to CB, even if the purpose of the trip is to receive a particular type of service (such as a physician service) that is, itself, categorically excluded from the CB requirement.However, effective April 1, 2000, the Balanced Budget Refinement Act of 1999 (BBRA 1999, Section 103) excluded from SNF CB those ambulance services that are necessary to transport an SNF resident offsite to receive Part B dialysis services (Social Security Act, Section 1888(e)(2)(A)(iii)(I)).
Transfers Between Two SNFs
A beneficiary’s departure from an SNF is not considered to be a “final” departure for CB purposes if he or she is readmitted to that or another SNF by midnight of the same day (see 42 CFR 411.15(p)(3)(iv)). Thus, when a beneficiary travels directly from SNF 1 and is admitted to SNF 2 by midnight of the same day, that day is a covered Part A day for the beneficiary, to which CB applies. Accordingly, the ambulance trip that conveys the beneficiary would be bundled back to SNF 1 since, under §411.15(p)(3), the beneficiary would continue to be considered a resident of SNF 1 (for CB purposes) up until the actual point of admission to SNF 2.
However, when an individual leaves an SNF via ambulance and does not return to that or another SNF by midnight, the day is not a covered Part A day and, accordingly, CB would not apply.
Roundtrip to a Physician’s Office
If an SNF’s Part A resident requires transportation to a physician’s office and meets the general medical necessity requirement for transport by ambulance (i.e., using any other means of transport would be medically contraindicated) (see 42 CFR 409.27(c)), then the ambulance roundtrip is the responsibility of the SNF and is included in the PPS rate. The preamble to the July 30, 1999 final rule (64 Federal Register 41674-75) clarifies that the scope of the required service bundle furnished to Part A SNF residents under the PPS specifically encompasses coverage of transportation via ambulance under the conditions described above, rather than more general coverage of other forms of transportation.
Noncoverage of Transportation by Any Means Other Than Ambulance
In contrast to the ambulance coverage described previously, Medicare simply does not provide any coverage at all under Part A or Part B for any non-ambulance forms of transportation, such as ambulette, wheelchair van, or litter van. Further, as noted in the preceding section, in order for the Part A SNF benefit to cover transportation via ambulance, the regulations at 42 CFR 409.27(c) specify that the ambulance transportation must be medically necessary–that is, that the patient’s condition is such that transportation by any other means would be medically contraindicated. This means that in a situation where it is medically feasible to transport an SNF resident by means other than an ambulance–for example, via wheelchair van–the wheelchair van would not be covered (because Medicare does not cover any non-ambulance forms of transportation), and an ambulance also would not be covered (because the use of an ambulance in such a situation would not be medically necessary). As with any noncovered service for which a resident may be financially liable, the SNF must provide appropriate notification to the resident under the regulations at 42 CFR 483.10(b)(6), which require Medicare-participating SNFs to “. . . inform each resident before, or at the time of admission, and periodically during the resident’s stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare or by the facility’s per diem rate.”
Tags: ambulance billing, Consolidated Billing, DME, ems billing, Medicare, Part A Stay, SNF, wheelchair van
Posted in Cahaba, Medicare, Palmetto | No Comments »
January 14th, 2009
Dear Cahaba_News Medicare Part B Ambulance Members,
Ambulance Corrections
The Centers for Medicare and Medicaid Services (CMS) allows providers to take advantage of the telephone reopening line to make simple corrections to processed Medicare claims.
In reviewing several of the ambulance appeals received, it is noted that there are a lot of corrections being sent in as appeals by ambulance providers that can be reviewed on the telephone reopening line. Specifically, allowing ambulance providers to call in only those corrections that require a GW modifier be added to the claim. These are not appeals, but simply corrections to claims that denied because the modifier was not used and the patient was in a Hospice environment.
Effective, Monday, February 9, 2009, if you have a claim that falls into this category and has been denied, you can call the toll-free Clerical Error Reopening lines to get the claim corrected. The Clerical Error Reopening lines are located at
http://www.cahabagba.com/part_b/contact_phone.htm. This will save time and expedite payment avoiding needless paperwork and delays due to timeliness factors for appeals. Additional information on Clerical Error Reopenings is located on our Web site at http://www.cahabagba.com/part_b/claims/clerical_error_reopen.htm.
Tags: ABC, ambulance billing, Cahaba, Medicare, Part B
Posted in Cahaba | No Comments »
January 14th, 2009
Just a reminder about billing for DOA:
‘‘No Transport’’ Calls and Pronouncement of Death - If an ambulance supplier responds to an emergency call, but a patient is not transported due to death, three Medicare rules apply.
1. If an individual is pronounced dead prior to the time the ambulance was requested, there is no payment.
2. If the individual is pronounced dead after the ambulance has been requested, but before any services are rendered, a BLS payment will be made and no mileage will be paid.
3. If the individual is pronounced dead after being loaded into the ambulance, the same payment rules apply as if the beneficiary were alive.
Tags: ABC, ALS, billing, BLS, DOA, Medicare
Posted in ABC Update | No Comments »
January 8th, 2009
This post is courtesy of West Virginia Office of EMS:
History was made January 7, 2009, as Paramedic Mike Alt of the NIOC Sugar Grove Fire and Emergency Services Department in Pendleton County submitted West Virginia’s first electronic patient care record.
The record was successfully submitted through WVPreMIS, West Virginia’s premiere Electronic Patient Care Record (EPCR) data submission and management system.
The Electronic Patient Care Record is designed to replace the current paper-based record that squads must submit after each response. The new electronic format will open the door to data and quality analysis, and will allow squads and the EMS system to focus on performance metrics with the goal to improve the quality of pre-hospital care in the State.
WVPreMIS, the de-facto standard EPCR system for West Virginia, was designed and developed by the EMS Performance Improvement Center (EMSPIC) of North Carolina. The West Virginia Office of EMS began its partnership with EMSPIC in the winter of 2007, and has been working to implement West Virginia’s unique standards into the system. Access to WVPreMIS will be provided to squads free of charge in order to boost adoption in the State and provide a benchmark for EPCR system quality.
While a handful of small set-backs have been presented during the course of development, EMSPIC has worked diligently to deliver a production-ready product for first quarter 2009 deployment.
Squads planning their move to the electronic patient care record platform can either adopt WVPreMIS or implement one of West Virginia’s certified third-party EPCR solutions. Only certified systems and WVPreMIS may submit electronic run data in West Virginia.
Squads are encouraged to talk with the West Virginia State Office of EMS, approved vendors, and the EMS Performance Improvement Center to determine the best solution to fit their needs.
Tags: Ambulance, EMS, ePCR, WVOEMS
Posted in EMS Association News | No Comments »
January 7th, 2009
In order to provide up-to-date information on ambulance industry issues, ABC is launching a new blog! Please refer back here for details on vital reimbursement issues, EMS association updates from around the country, news in the ambulance industry and more!
Posted in ABC Update | No Comments »
|
|
