Saturday, July 20, 2019

Ambulance - round trip, bridge, multiple arrival - how to bill

SPECIAL SITUATIONS on Ambulance billing

INTERCEPTS


In situations where a BLS vehicle intercepts with an ALS vehicle, each provider may bill for the appropriate base rate and for the loaded mileage they provided (if any).

 BRIDGE/TUNNEL TOLL


Bridge and tunnel toll charges are reimbursable to the ambulance provider, both loaded and return trip.

Billing instructions:

* The Unlisted Ambulance Service code must be used.

* All toll charges must be combined on one claim line.

* The Remarks section must contain the bridge or tunnel name and the number of times used.



3.3 CONTINUOUS OR ROUND TRIP TRANSPORT

This type of transport is considered to be one run. The base rate code for the highest level of service performed during transport should be billed on one claim line. Loaded mileage is also billed on one claim line with the total number of whole (loaded) miles indicated as the quantity.

Refer to the Waiting Time subsection of this chapter in cases where waiting time exceeds 30 minutes.


NURSING FACILITIES

Routine, non-emergency medical transportation provided for NF residents in a van or other nonemergency vehicle is included in the facility's per diem rate. This includes transportation for medical appointments, dialysis, therapies, or other treatments not available in the facility.

When the resident’s attending physician orders non-emergency transportation by ambulance (due to the need for a stretcher or other emergency equipment), the ambulance provider may bill MDHHS directly.

The ambulance provider must maintain the physician's written order as documentation of medical necessity.

If the resident’s attending physician does not order non-emergency ambulance transport, arrangements for payment must be between the facility and the ambulance provider, and cannot be charged to the resident, the resident's family, or used to offset the patient-pay amount. This cost may not be claimed as a routine cost on Michigan’s Medicaid cost report. The cost of non-emergency ambulance transports not ordered by the resident’s physician must be identified and removed on Worksheet 1-B by the NF. For direct reimbursement by MDHHS to an enrolled ambulance provider for services provided to a Medicaid beneficiary who is a resident of a NF, refer to the Ambulance Quick Reference Guide Section of this chapter.


 MULTIPLE ARRIVALS

When multiple units respond to a call for services, only the entity that actually provides services for the beneficiary may bill and be paid. The entity that rendered service/care should bill for all services furnished.

 MULTIPLE BENEFICIARIES PER TRANSPORT

When more than one eligible beneficiary is transported at the same time, the only acceptable duplication of charges is half of the base rate. Separate claims must be submitted for each beneficiary. The first claim is completed in the usual mannerand the base rate billed must reflect the highest level of service performed.

Claims for additional beneficiaries must indicate the U&C base rate charge. The appropriate modifier must be reported. Providers should refer to the Billing & Reimbursement for Professionals or the Billing & Reimbursement for Institutional Providers chapters of this manual, as appropriate, for a list of modifiers.

Payment is made at 50 percent of Medicaid's reimbursement rate or 50 percent of the provider's charge (whichever is less).



 MULTIPLE TRANSPORTS PER BENEFICIARY

Multiple ambulance transports rendered to the same beneficiary on the same date of service are covered under certain conditions. Information regarding billing and PA for multiple transports for the same beneficiary on the same date of service is contained in the Billing & Reimbursement for Institutional Providers and the Billing & Reimbursement for Professionals
Chapters of this manual.


OUT OF STATE NONBORDERLAND TRANSPORTS

Except for emergencies, out of state, nonborderland transports require PA. (Refer to the General Information for Providers chapter of this manual for additional information.) The ambulance provider, home health agency (HHA), hospital, NF, physician, or social worker may request this authorization. The ambulance provider must retain documentation of medical necessity (physician's order) in the beneficiary's file to support the need for ambulance transportation. To request
authorization, the requestor must call or write the MDHHS Program Review Division before services are rendered. (Refer to the Directory Appendix for contact information.) The request must include:

* Point of pick-up

* Beneficiary's name and Medicaid ID number

* Diagnosis

* Service to be provided

* Destination point

* Reason why the ambulance transport was medically necessary

* Reason why the beneficiary cannot be transported by any other means

* Name and address of the ambulance provider

* Requestor's name


Based on the authorization requested, MDHHS approves or denies the request. The ambulance provider may render the service upon receipt of verbal approval. A copy of the approval authorization letter is mailed to the ambulance provider following the verbal authorization. The ambulance provider may not bill Medicaid until he has received the authorization letter. The ambulance provider must keep a copy of the authorization letter in the beneficiary's file.

The requestor must notify the MDHHS Program Review Division of any changes to the approved PA (e.g., change in service date or ambulance provider, etc.).

When seeking reimbursement for out of state transports, the PA number must be entered on the claim, except in the case of emergency transports.

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