News

The following comes to us from TrailBlazer:

TrailBlazer has identified an error with payment files used to process ambulance ground service claims for three Texas localities, resulting in an underpayment of these claims.

Texas EMS Rodeo National Refresher and EMS Conference
Posted August 12, 2008

The Texas EMS Rodeo Paramedic Refresher and EMS Conference is designed to provvide the Section I requirements of the National Registry curriculum by introducing students to new information that continues their EMS education.

Read more here:
http://www.consurgo.org/rodeo.html

The following comes to us from AAA:

The ambulance inflation factor, used to increase Medicare reimbursement rates each year for ambulance, is based on the increase in the CPI Urban, from June to June each year. Based on the statistics published by the U.S. Department of Labor on July 16, 2008, the increase in the CPI – Urban from June 2007 to June 2008 was 5.02%. Thus, at this time, it appears the increase will be 5.0%. However, the Department of Labor has adjusted the monthly CPI increases in the past, although only very slightly.

So, it is possible this could change, but for now, the ambulance inflation factor for 2009 will be 5.0%. We will let you know the official inflation factor when the Centers for Medicare and Medicaid Services publish that figure later this year. Please note: the 5% inflation update is in addition to the 2% urban and 3% rural increases that were included in the recently enacted physician fix package, and are retroactive to July 1, 2008.

CMS Proposes Changes to Signature Rule and Other Regulations
Posted July 8, 2008

On July 7, 2008, the Centers for Medicare and Medicaid Services (CMS) published a Proposed Rule in the Federal Register that would make further modifications to the Medicare signature rules for ambulance services. The Proposed Rule contained several other provisions that would also affect ambulance services.

There is a great deal of confusion abound regarding a notice from CMS about a 10-day hold on Medicare claims paid under the Medicare Physician Fee Schedule for July dates of service. To be clear, this hold is not intended to effect ambulance clients of Health Claims Plus which are paid under the Medicare Ambulance Fee Schedule--we have confirmed this with TrailBlazer. Health Claims Plus is closely monitoring the status of claims submitted to Medicare and will alert providers in the event of unforeseen delays, however such delays are not expected.

Beginning June 11th, Medicare will begin holding all claims from processing and payments for Texas Part B providers while they implement an edit (J4) to their EDI claims processing system.

From TrailBlazer:
"Part B electronic claims submitted between June 11 and June 16, 2008, will be held due to J4 implementation. TrailBlazer will systematically release claims into the standard processing system, in date received order, after June 17, 2008. It is anticipated this process may take several days. Even though these claims will be held, they will be Julian dated appropriately and payment to providers should not be delayed."

Health Claims Plus is taking appropriate measures to comply with the new EDI edit and will also be submitting claims in a routine manner for all providers even during the hold time. Part B providers should be aware that due to this hold, claims processing and payments will stop completely for what we consider and extended period of time (6 days). Claims processing and payments will resume on June 17th.

Resources:
- http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=4&ID=12389
- http://www.trailblazerhealth.com/Publications/Job%20Aid/J4EDIChanges.pdf?DomainID=1

For prior authorizations submitted on or after October 31, 2007, the maximum authorization period for nonemergency ambulance transports has changed to 180 days for the Texas Medicaid Program.

Providers that request an annual authorization on or after October 31, 2007, may be issued a long-term 180-day authorization if all of the requirements are met. Authorizations for 180-day periods will only be issued if the client meets medical necessity and the requesting provider submits the Physician’s Medical Necessity Certification for Nonemergency Ambulance Transports form. A copy of the Physician’s Medical Necessity Certification for Nonemergency Ambulance Transports form is available here. (~Texas Medicaid Bulletin No. 214)

Sample Ambulance Patient Signature Forms *Updated 1/29/08*
Posted December 28, 2007

A national ambulance law firm, Page Wolfberg & Wirth, has made sample Medicare Patient Signature Forms available for viewing and downloading at their website. You may access them here:
http://www.pwwemslaw.com/content.aspx?id=326

SNF Consolidated Billing as it Relates to Ambulance Services
Posted December 4, 2007

What You Need to Know:

Note: The special edition article was revised October 9, 2007, to provide clarification on page 3 regarding “trips for excluded outpatient services.” This clarification is intended to state explicitly that the consolidated billing exclusion for ambulance trips related to the receipt of excluded outpatient hospital services would apply to the entire ambulance round-trip (the SNF-to-hospital trip plus the return trip back to the SNF), and not just to the outbound (SNF-to-hospital) portion alone. All other information remains the same.

This special edition article describes SNF consolidated billing as it applies to ambulance services for SNF residents. The SNF consolidated billing requirement makes the SNF responsible for including on the Part A bill that it submits to its Medicare Fiscal Intermediary (FI) almost all of the services that a resident receives during the course of a Medicare-covered stay, except for a small number of services that are specifically excluded from this provision. These “excluded” services can be separately furnished to the resident and billed under Medicare Part B by a variety of outside sources. Ambulance services have not been identified as a type of service that is categorically excluded from the consolidated billing provisions. However, certain types of ambulance transportation have been identified as being separately billable in specific situations, i.e., based on the reason the ambulance service is needed.

Revised MLN Matters Article: Medicare Payments for Ambulance Transports - CMS SE0724
Posted December 4, 2007

The following information comes from CMS:

Note: This article was revised November 16, 2007, to correct a reference to a related Change Request (CR). The reference should have been to CR 5442 instead of CR 5422.The article had previously been changed on November 8, 2007, to clarify when an ambulance transport claim may result in a beneficiary liability (see “Caution” section). In addition, there was a change in the “Documentation Requirements” section to note that a Physician Certification Statement (PCS) is required for non-emergency transports only “in some circumstances.” It previously implied that it was always required. All other information remains the same.

The article, titled “Medicare Payments for Ambulance Transports,” is available on the CMS MLN Matters Web page at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0724.pdf

What You Need to Know:

According to a recent study conducted by the Office of the Inspector General (OIG), “Medicare Payments for Ambulance Transports,” during Calendar Year (CY) 2002, 25 percent of ambulance transports did not meet Medicare’s program requirements. Liability for overpayment resulting from a denied ambulance transport claim depends on the type of denial. A denial due to coverage reasons may result in a liability to the Medicare beneficiary unless the beneficiary lacks constructive knowledge that the service is not covered. Claims denied due to level of service requirements are often downcoded to a lower level of ambulance service. In this case, the ambulance supplier is generally liable in the event of an overpayment. This article includes information regarding Medicare’s coverage of ambulance transports, documentation requirements and tips on how to avoid improper billing.

Congress is set to consider Medicare ambulance relief in December. Take action now by contacting your local members of Congress. Click here to read this important 'Call to Action' announcement now.

Patient Signature Requirements Significantly Changed in Medicare Final Rule
Posted November 29, 2007

Thanks to a new ruling by CMS, Signature requirements for filing Medicare claims in instances where the beneficiary is unable to sign will change significantly as of January 1, 2008. Click here for all the information.

We apologize for any inconvenience you may have experienced in accessing our site or emailing us in the past 12 to 20 hours. A bandwidth protection script was not properly configured and locked our website to incoming traffic for an extended period of time while our offices were closed over night. This issue was corrected first thing this morning and web communications have been restored to normal.

CMS Publishes Proposed Signature Rule
Posted July 16, 2007

On July 12th, Medicare published a Proposed Rule in the Federal Register that would modify the patient signature requirements for ambulance providers filing Medicare claims in cases where they cannot obtain the signature of the patient or another authorized signer. PWW has just posted a summary of the Proposed Rule on their website, www.pwwemslaw.com. Medicare is accepting comments on the Proposed Rule until August 31, 2007.

In what is sure to be one of the more controversial elements of the Proposed Rule, Medicare is proposing that ambulance services be required to obtain a "signed contemporaneous statement" from a representative of the receiving facility documenting the date and time the patient was received at the facility.

Visit the "Ambulance Billing/Medicare" page of PWW's "EMS Law Library" to download the Proposed Rule, as well as to read PWW's summary.

This week Health Claims Plus celebrates an important time of recognition in our nation. Read about it here.

TrailBlazer announced today its intentions to begin probing and reviewing providers due to an increase in non-emergency BLS transports (A0428). Health Claims Plus is prepared to cooperate with any reviews that may effect our current and future clients. You can read about TrailBlazer's decision here.

Health Claims Plus recommends that all EMS services review new information from CMS regarding emergency services and requirements for hospitals. You can read the announcement by clicking here.

Don't be the last to get important updates from Trailblazer. Join their listserv e-mailing list by clicking here.

Our office will be closed on Friday, April 6th, in observance of Good Friday. We'll reopen Monday morning at 8:00 AM.

In the latest issue of the MLN Matters, CMS has issued an update regarding Part B deductibles. You can access it by clicking here.

CMS has released the 2007 Ambulance Fee Schedule. You can access it by clicking here.

Don't be the last to get important updates from Trailblazer. Join their listserv e-mailing list by clicking here.

Merry Christmas and Happy New Year from Health Claims Plus
Posted December 23, 2006

Everyone at Health Claims Plus would like to wish you and your families a very Merry Christmas and a Happy Prosperous New Year!

Join TrailBlazer's Emergency Information Listserv. Click here for more information.

Health Claims Plus wishes you a very Happy Thanksgiving. In observance of the holiday, our offices will be closed on November 23rd & 24th. We'll reopen Monday morning, November 27th.

Thanks to all of you who stopped by our booth at the Texas EMS Expo. We enjoyed meeting you all.

Be sure to stop by our booth (#831) at the Texas EMS Expo in Dallas! We look forward to visiting with you and showcasing the features of our services if you're interested.

The Center for Medicare & Medicaid Services has updated the "Ambulance Inflation Factor" for 2007. Click here to read review the information from CMS.

In order to complete migration to a new accounting system, Medicare will implement a brief payment hold for nine days in September. Click here to read the announcement from TrailBlazer.

In order to migrate to a new accounting system, Trailblazer will be holding payments for five days in August. Click here to read the announcement from TrailBlazer.

Health Claims Plus has a solution to the end in paper Medicare remittance advice. Click here to read this announcement now.

The Centers for Medicare & Medicaid Services has published a tip for providers to consider when applying for their National Provider Identifier. Click here to read this publication now.

We have made the decision to continue support STATco's EMSData2k software to better serve our clients. Click here to read this announcement now.

Beginning June 1st, Medicare will no longer be sending paper remittance to providers already receiving electronic remittance. Click here to read this announcement now.

An important announcement regarding UHC EPS & GPNet Online enrollment has been mailed to all current EMS clients (as of Friday, 3/31/06). Click here to read this announcement now.

Important Announcement Re: Electronic Charting / Reporting
Posted March 29, 2006

An important announcement regarding electronic charting and reporting has been mailed to all current EMS clients (as of Friday, 3/31/06). Click here to read this announcement now.

The 2006 Ambulance Training Manual has been revised and made available online from TrailBlazer Health Enterprises. You can access the 2006 Ambulance Training Manual and other informative resources on TrailBlazer's website, or by clicking here.

Join Health Claims Plus on Tuesday, March 7th, at the Humble Civic Center from 1:00PM to 5:00PM. Learn what constitutes ambulance fraud and how to avoid it. FBI Special Agent, Vic Hartman, will advise attendees on federal laws and how to keep your service within those guidelines of the law. A presentation on proper PCR documentation will also be given by our knowledgeable staff. Please join us!

Health Claims Plus is proud to announce the availability of web-based charting services. For more information, including a list of features and requirements, read the entire announcement here.

Effective June 1, 2006, Health Claims Plus will no longer be supporting electronic run submissions from STATco's EMSData2k product. For information on our new alternative offer, including a list of features and requirements, click here to read the entire announcement.

Ambulance Fee Schedule - CY 2006 Update: Correction to CR 4061, CMS CR 4362 - CMS has released an article regarding the ambulance fee schedule - CY 2006. This article conveys that, CR 4061, “Ambulance Inflation Factor for CY 2006” (released Nov. 25, 2005), contained an incorrect file name for the CY 2006 Ambulance Fee Schedule File. CR 4362, from which this article is taken, corrects that file name. Your carriers and FIs will use this corrected file to determine the payment limit for ambulance services that you furnish during CY 2006. The article, titled “Ambulance Fee Schedule - CY 2006 Update: Correction to CR 4061 ”, is available on the CMS Medlearn Matters Web page.

CMS has issued corrections for the issue which temporarily disrupted the processing of Medicare claims.

The Centers for Medicare & Medicaid Services has released a new notice concerning the "inflation factor" in regards to the new 2006 fee schedule for ambulance services. Click here to view the notice.

We'd like to thank everyone who took the time to stop by our booth at the EMS Expo in Austin, TX. It's always exciting to make new contacts with individuals who are as excited about the EMS business as we are. Congratulations to Mike Click of the Brownfield Regional Medical Center, winner of our 1st prize, a new laptop; and to Bruce Banz of City of De Soto Fire/Rescue, winner of our 2nd prize, a new camcorder. If you visited our booth in Austin and would like more information, please call us toll-free at 888.483.9893.

We are happy to report that our server migration from our home office in Liberty, TX to our new data center in Kansas City, MO, was a huge success. There seemed to be no extended periods of downtime, nor were there any major glitches during the process. Our new server is bigger, faster, and more powerful. In 2006, HCP clients will see the benefits of this upgrade. Thanks again for your patience while we strive to better serve you.

We're always looking for ways to improve our customer support quality. For this very reason, we have added illustrated tutorials for performing common and uncommon tasks using our licensed STATco EMSData2k run submission software. To access these tutorials and see what is available, click here to access the STATco Support page.

National Modifier & Condition Code for Disaster Related Claims
Posted October 3, 2005

Centers for Medicaid Services has announced the creation of national modifiers and condition codes for claims related to Hurricane Katrina and other disaster victims.

Health Claims Plus has resumed business operations as of Friday, September 30, 2005. Our facilities sustained heavy external damage, and our electrical and network infrastructure has been disabled since the landfall of the storm. We finally completed temporary patches to our building yesterday, and as of last night have been restored to full power by City of Liberty power crews.

We are pleased to inform you that all our staff members made it through the storm okay. We are especially thankful to Kenny Jones at Coastal EMS for providing our employees and families with lunch on Wednesday, September 28, 2005. We're also very thankful to all our clients who offered their facilities, time, and best wishes while we recovered from Hurricane Rita.

Over the next day or so, our website and email service may experience interruptions as we propagate network traffic from our backup servers to our local servers. During this time, please do not assume that STATco™ submissions or emails to our staff have been successful.

We are happy to be back in the office and look forward to working hard to continue providing excellent billing and collection services. If you have any questions or concerns, please give us a call at (888)483-9893.

*****Hurricane Update - (9/20/2005)*****

We are monitoring the progress of Hurricane Rita closely and have reviewed our contingency plan to ensure that we are prepared to handle any circumstances that result from the landfall of the major storm. We encourage those who may be affected by Rita to visit the National Hurricane Center website for up-to-date information, as well as information on how to prepare for the storm, and provide the necessities for you and your loved ones.

In the past couple of days, we have made some upgrades & changes to our website. These upgrades & changes can be expected to be ongoing, as we continue to implement upgrades in the weeks and months to come. Stay tuned to HealthClaimsPlus.com as we implement new features to our already outstanding services.

During the month of August, Health Claims Plus saw the implementation of a new staffing arrangement. Several new positions were created to further enhance our services. It is our hope that the new arrangement will allow us to dedicate more resources to the necessities your service requires on a day to day basis. For a listing of all our latest contact information, please click here.

Health care providers are required by law to apply for a National Provider Identifier (NPI). To apply online, visit https://nppes.cms.hhs.gov, or call 1-800-465-3203 to request a paper application.