Monday, November 15, 2010

BLS/ALS Joint Responses & dialysis transport billing tips

SPECIAL COVERAGE CONSIDERATIONS

BLS/ALS Joint Responses

In situations where a BLS entity provides the transport of the beneficiary and an ALS entity provides a service that meets the definition of an ALS intervention, the BLS supplier may bill Medicare the ALS rate provided that a written agreement between the BLS and ALS entities exists. Providers/suppliers must provide a copy of the agreement or other such evidence (e.g., signed attestation) as determined by their intermediary or carrier upon request. Medicare does not regulate the compensation between the BLS and ALS entities. The written agreement must be in place prior to submitting the Medicare claim. If no agreement between the BLS and the ALS entity exist, then only the BLS level of payment may be made. The ALS entity’s services are not covered and the beneficiary is liable for such expenses.

Dialysis Transports

A beneficiary receiving maintenance dialysis on an outpatient basis does not ordinarily require ambulance transportation for dialysis treatment, whether the facility is an independent enterprise or part of a hospital. Ambulance services furnished to a maintenance dialysis patient are not payable unless documentation submitted with the claim shows that the patient’s condition required ambulance services and the facility meets the destination requirements. Claims for non-routine round trip ambulance services to outpatient dialysis facilities must document medical necessity.

Dry Runs, or Billing for Denial

The Medicare Ambulance Benefit is a transportation benefit. If no transportation occurs there is no benefit. It is not a covered service under Medicare. This is typically referred to as a “dry run.” You may bill the patient directly for services and/or supplies associated with a “dry run.” Medicare does not need to receive a bill for a “dry run.” If requested by the patient, or if a formal Medicare denial of such services is necessary for secondary billing you may submit a claim to Medicare for denial. Please bill all service lines with a “GY” modifier only and entered “Dry Run – billing for denial only” in the comments field (NTE02).

Example:
02022006 0202200641 A0428 GY 1 1
02022006 0202200641 A0425 GY 1 25

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