AAA Government Affairs E-Update - Additional Items

July 22, 2010

1. Update on Payments at New Medicare Rates

2. Correction to Advisory on Medicare Signature Requirements

3. CMS Announces Details of August Ambulance Open Door Forum

1. Update on Payments at New Medicare Rates

By David M. Werfel, Esq.

The first portion of this update only refers to the 2010 rates that are supposed to be paid with claims processed on or after July 6th.

We have been able to determine that some carriers are paying rates incorrectly, e.g. Noridian is paying rates for transports in urban areas as if the transports were in super-rural areas.  Noridian intends to fix the problem with a mass adjustment, offsetting against on-going claims. Thus, there is nothing for providers in states where Noridian processes the claims to do at this time, other than to check Remittance Notices, now as well as in the near future, until this is resolved.

Regardless of what state you are in, we suggest you check your Remittance Notices, for claims with 2010 dates of service but processed after July 6 to see if the rates are correct.  The correct rates can be accessed from the AAA Rate Calculator or from the CMS website: http://www.cms.gov/AmbulanceFeeSchedule/02_afspuf.asp#TopOfPage.

With respect to the retroactive adjustments, at least one carrier, NGS has started to make those payments.  However, most Carriers are waiting for further instructions from CMS as to the methodology for making these adjustments, e.g. should it be one mass adjustment, do they have to have to process as separate claims, etc.

2. Correction to Advisory on Medicare Signature Requirements

By David M. Werfel, Esq.

In the Member Advisory on Medicare Signature Requirements issued earlier today, we should have used the word "completed" rather than "signed" in reference to the attestation statement.  The attestation statement from CMS references the provider as attesting that the signature or notations made were by the person signing the attestation statement. A corrected Advisory is below with the word change in bold underlined text.

Recently, Railroad Medicare has required trip reports with the signature of the crew member that completed the trip report.  This is the result of CMS amending Program Integrity Manual, 100-08, Chapter 3, section 3.4.1.1(B) to state that "For medical review purposes, Medicare requires that services provided/ordered be authenticated by the author.  The method used shall be a handwritten or an electronic signature.  Stamp signatures are not acceptable".

While this may have been intended for physician orders and other documents, it does apply to your trip reports.  Therefore, whether your state requires the crews to sign or not, advise the crews immediately that they must sign their trip reports.  Please note, it is the author of the document that must sign, but it is a good practice to have all crew members sign.

This is in addition to a prior Transmittal (issued on March 28, 2008) that added the language for legibility, in stating:

"Medicare requires a legible identifier for services provided/ordered.  The method used shall be hand written or an electronic signature (stamp signatures are not acceptable) to sign an order or other medical record documentation for medical review purposes".

Since signatures by crew members may not be legible, it would also be a good practice to:

1. Have the crews print their names.

2. Have the crews list their certification/license number.

3. Keep a signature log of all crew members.  This need be nothing more than a list of each crew member, with their name, certification number, their signature and date signed.

This went into effect April 16, 2010.  Therefore, for transports on or after April 16, 2010, if the crew did not sign the trip report, you could have them sign an attestation form (the form is included in the CMS Transmittal) acknowledging that they completed particular trip reports.  The alternative is to wait and, if ever audited, then get the attestation forms for the trip reports that correspond to the claims in the audit.  The problem with that approach, of course, is that the crew member may no longer be employed by you when the audit occurs.

It is also a good idea to maintain a signature log which lists the names, license/certification numbers and signatures of all crew members as that can be used if the auditor can not read the signature of the crew.

3. CMS Announces Details of August Ambulance Open Door Forum

The next Ambulance Open Door Forum will be held Tuesday, August 3, at 2:00 p.m. (eastern).  To participate in the Forum, dial 1-800-837-1935 and provide the operator with the conference ID number of 89679492 and your name, organization name and the state from which you are calling.  Below are more details on the Forum.

CMS Ambulance Open Door Forum

Date: Tuesday, August 3, 2010

Time: 2:00 to 3:00 p.m. (eastern)

Conference Call Number: 1-800-837-1935

Conference ID: 89679492

Conference Leaders: Dr. Bill Rogers/John Warren/Natalie Highsmith

TTY Communications Relay Services are available for the hearing impaired.  For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://relayservices.att.com/.  A relay communications assistant will help.

ENCORE: Call Number 1-800-642-1687; Conference ID Number of 89679492.

"Encore" is a recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conference ID number of 89679492.  You can access the recording of the call from Tuesday, August 3, after 5:00 p.m. (EST) through Friday, August 6.