Saturday, May 28, 2016

Medicare payment Guideline for Multiple patient on same trip


Multiple Patients on One Trip

Ambulance suppliers submitting a claim using the ASC X12 professional format or the CMS-1500 paper form for an ambulance transport with more than one Medicare beneficiary onboard must use the “GM” modifier (“Multiple Patient on One Ambulance Trip”) for each service line item. In addition, suppliers are required to submit documentation to A/B MACs (B) to specify the particulars of a multiple patient transport. The documentation must include the total number of patients transported in the vehicle at the same time and the health insurance claim (HIC) numbers for each Medicare beneficiary. A/B/MACs (B) shall calculate payment amounts based on policy instructions found in Pub.100-02, Medicare Benefit Policy Manual, Chapter 10 – Ambulance Services, Section 10.3.10 – Multiple Patient Ambulance Transport.


Ambulance claims submitted on or after January 1, 2011 in version 5010 of the ASC X12 837 professional claim format require the presence of a diagnosis code and the absence of said diagnosis code will cause the ambulance claim to not be accepted into the claims processing system. The presence of a diagnosis code on an ambulance claim is not required as a condition of ambulance payment policy. The adjudicative process does not take into account the presence (or absence) of a diagnosis code but a diagnosis code is required on the ASC X12 837 professional claim format.


Coding Instructions for Form CMS-1491


Effective April 2, 2007, Form CMS-1491 will no longer be a valid format for submitting claims. Suppliers who wish to submit a paper claim must use CMS-1500 Form.

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