Medicare Ambulance billing. Ambulance billing codes, Air ambulance billing guide and reimbursement. How and what code to use for correct payment.
Friday, November 18, 2016
Medicare Payment for Ambulance Services Furnished by Certain CAHs
Medically necessary ambulance services furnished for dates of service on or after December 21, 2000 and prior to January 1, 2004, by a CAH or by an entity that is owned and operated by the CAH are paid based on 100 percent of the reasonable costs if the 35 mile rule for reasonable cost-based payment is met.
For dates of service on or after January 1, 2004, medically necessary ambulance services furnished by a CAH or by an entity that is owned and operated by the CAH are paid based on 101 percent of the reasonable costs if the 35 mile rule for reasonable cost-based payment is met.
For dates of service on or after December 21, 2000 and prior to October 1, 2011, in order for the 35 mile rule to be met, the CAH or the entity that is owned and operated by the CAH, must be the only provider or supplier of ambulance services located within a 35 mile drive of the CAH or the entity.
For dates of service on or after October 1, 2011, in order for the 35 mile rule to be met, the CAH or the entity that is owned and operated by the CAH, must be the only provider or supplier of ambulance services located within a 35 mile drive of the CAH. Additionally, if there is no provider or supplier of ambulance services located within a 35 mile drive of the CAH but there is an entity owned and operated by the CAH located more than a 35 mile drive from the CAH, that CAH-owned and operated entity can only be paid 101 percent of reasonable costs for its ambulance services if it is the closest provider or supplier of ambulance services to the CAH.
Section 205 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 exempts certain CAHs from the current Medicare ambulance cost per trip payment limit as well as from the ambulance fee schedule. Section 205(a) of BIPA states:
The Secretary shall pay the reasonable costs incurred in furnishing ambulance services if such services are furnished (A) by a CAH (as defined in §1861(mm)(1)), or (B) by an entity that is owned and operated by a CAH, but only if the CAH or entity is the only provider or supplier of ambulance services that is located within a 35-mile drive of such CAH.
Those CAHs and CAH-owned and operated entities that meet the 35 mile rule for reasonable cost-based payment shall report condition code B2 (CAH ambulance attestation) on their bills.
When the 35 mile rule for reasonable cost-based payment is not met, the CAH ambulance service or the ambulance service furnished by the entity that is owned and operated by the CAH, is paid based on the ambulance fee schedule.
Labels:
ambulance billing basic
Subscribe to:
Post Comments (Atom)
Popular Posts
-
I have received a denial for my submission of specialty care transport HCPCS code A0434. What could be wrong? Answer: Did you submit a p...
-
HCPCS A0429 – Ambulance service, BLS, emergency transport, all inclusive Basic Life Support (BLS) Emergency – When medically necessary, th...
-
Procedure code and description A0425 Ground mileage, per statute mile A0426 Ambulance service, advanced life support, nonemergency trans...
-
HCPCS A0433 – Advanced Life Support, Level 2 Advanced Life Support, Level 2 (ALS 2) – ALS2 is the transportation by ground ambulance vehic...
-
Procedure code and Description A0425 Ground mileage, per statute mile No PAR A0426 Ambulance service, advanced life support, nonemergency...
-
HCPCS procedure codes are used for Ambulance service The HCPCS procedure codes listed in the following table are the only reimbursable pro...
-
Origin and Destination Modifier Table The modifiers listed in the following Origin and Destination Modifier table are required for billin...
-
Procedure Codes for Air Services HCPCS A0430 – Ambulance service, conventional air services, transport, one way, fixed wing Fixed Wing (F...
-
HCPCS A0432 – Paramedic Intercept (PI), rural area transport furnished by a volunteer ambulance company, which is prohibited by state law fr...
-
Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity The autonomic nervous system (ANS) regulates physiologic p...

No comments:
Post a Comment