Thursday, October 14, 2010

Ambulance billing fee schedule - components and factor

Components of the Ambulance Fee Schedule

Ground Ambulance Services
1. Conversion Factor (CF) – A money amount used to develop a base rate for each level of ground ambulance service. The CF will be updated annually by the Ambulance Inflation Factor. The CF does not apply to mileage payment amounts.

2. Relative Value Unit (RVUs) – RVUs set a numeric value for ambulance services relative to the value of a base level ambulance service. Since there are marked differences in resources necessary to furnish the various levels of ground ambulance services, different levels of payment are appropriate. The RVUs are as follows:

Service Level RVU
BLS 1.00
BLS – Emergency 1.60
ALS1 1.20
ALS1 – Emergency 1.90
ALS2 2.75
SCT 3.25
PI 1.75

3. Geographic Adjustment Factor (GAF) – The GAF is one of two factors intended to address regional differences in the cost of furnishing ambulance services. The GAF for the ambulance FS uses the non facility practice expense (PE) of the geographic practice cost index (GPCI) of the Medicare physician fee schedule to adjust payment to account for regional differences. The geographic areas applicable to the ambulance FS are the same as those used for the physician fee schedule.
The location where the beneficiary was put into the ambulance (Point of Pickup (POP)) establishes which GPCI applies. For multiple vehicle transports, each leg of the transport is separately evaluated or the applicable GPCI. For the second (or any subsequent) leg of a transport, the POP establishes the applicable GPCI for that portion of the ambulance transport.
For ground ambulance services, the applicable GPCI is multiplied by 70 percent of the base rate. Again, the base rate for each category of ground ambulance service is the CF multiplied by the applicable RVU. The GPCI is not applied to the ground mileage rate.

4. Mileage – The ambulance fee schedule provides a separate payment amount for mileage. For payment purposes the term mileage refers to loaded mileage or the number of miles for which the beneficiary is transported in the ambulance. Payment is adjusted upward for ambulance services that are furnished in rural areas to account for the higher cost per ambulance trip. A rural area is defined as a U.S. Postal Service Zip code that is located, in whole or in part, outside of either a Metropolitan Statistical Area (MSA) or a New England County Metropolitan Area (NECMA), or in an area wholly within an MAS or NECMA that has been identified as rural under the “Goldsmith Modification”. (The Goldsmith modification establishes an operational definition of rural areas within large counties that contain one or more metropolitan areas. The goldsmith areas are so isolated by distance or physical features that they are more rural than urban in character and lack easy geographic access to health services.)

5. During the transition period, payment for separately billable supplies and ancillary services were calculated on the basis of the reasonable charge component of the blended rate only. Payment for these supplies is included in the base rates; therefore no separate payment is made under the fee schedule component. In 2005, the Medicare allowed amount was 20% of the reasonable charge. Beginning in 2006, supplies and ancillary services will no longer be separately billable.

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