June 10, 2010

AAA MEMBER ADVISORY

TO:          AAA Membership

FROM:    David M. Werfel, Esq.

                AAA Medicare Consultant

RE:          Summary of June 9 Ambulance Open Door Forum

On June 9, 2010, the Centers for Medicare and Medicaid Services (CMS) held its latest Open Door Forum for ambulance services.  CMS started out with only one notice, essentially discussing whether a hospital to hospital transport can be an emergency.  The definition of "emergency" (listed in the Regulation at 42 C.F.R. 414.605) and the frequently asked questions (FAQ) posted on their web site, were read on the call.  The web site for this FAQ is: http://questions.cms.hhs.gov/app/answers/detail/a_id/10033/kw/hospital%20transport/session/L3NpZC84UW1FM1Mxaw==

In sum, hospital to hospital transports can be billed as emergencies if they meet the definition for an "emergency response".

This was followed by a question and answer period.  As usual, many questions were not answered, other than CMS advising the caller to contact a specific person at CMS to follow-up on their question.  While nothing new was presented during the Open Door Forum, the more interesting answers were as follows:

• CMS has drafted the Transmittal to send to Carriers/Intermediaries and MACs with the new rates so they can start paying claims at the correct 2010 rates.  That Transmittal is in "clearance" so it should be sent very soon.
• Hospital to hospital transports where the facilities have the same Medicare provider ID number can be billed to Medicare if there is a change in the hospital status of the patient.  If the transport is from an in-patient to in-patient status, the hospital should be billed; if outpatient to in-patient Medicare should be billed.
• ER to a residence meets the origin/destination requirement, but still must meet the medical necessity requirement to be covered.  A completed PCS form is not necessarily enough.
• Transports from a residence to a physician's office are not covered, even if an ambulance is the only means of transporting the patient.  The reason for the transport not being covered is that it does not meet the destination requirement.
• A call that comes through on a 9-1-1 line to transport to an ER is not automatically covered.  The transport must still meet the medical necessity requirement.
• The hospital must be billed for a transport during an "interrupted stay", even if the patient has an emergency.
• Railroad is requiring that paper claims be signed, in ink, by the provider/supplier and, if not signed, an attestation form must be completed and submitted.

There were 337 participants on the call.  The next Open Door Forum for ambulance services will be held on August 4.