In an effort to resolve the confusion, KAPA is furnishing the following information for Kentucky's ambulance providers as supplied and reviewed by both AdminaStar and HCFA.

NOTICE OF DELAY FOR IMPLEMENTATION OF NEW NATIONAL AMBULANCE FEE SCHEDULE

In early December 2000, HCFA announced through their Program Memorandum AB-00-118 that the implementation of the new National Ambulance Fee Schedule would be delayed until some future date. Despite the delay in implementation of the entire new National Ambulance Fee Schedule, some of the changes began on January 1, 2001.

NEW CHANGES FOR AMBULANCE PROVIDERS EFFECTIVE JANUARY 1, 2001

The following two changes BEGAN on January 1, 2001 and are REQUIRED on all claim submissions.

1. Use of the new HCPCS codes EXCEPT FOR MILEAGE which providers would continue to use Old HCPCS mileage codes for BLS and ALS transports.

2. Use of the zip code for the PICK-UP LOCATION (Origination) on all claims. USE OF THE ZIP CODE FOR THE DESTINATION IS NOT REQUIRED. The Zip Code for the Pick-Up location should be reported in ITEM 23 (NOT ITEM 32) on the HCFA 1500; or Item 12 on the HCFA 1491.

Claims for ambulance transportation rendered on or after January 1, 2001, either electronic or paper, that do not comply with the two changes listed above WILL be returned/rejected without exception. Providers may resubmit these claims once they have been corrected, as a claim decision was never reached.

The changes that have been DELAYED until the new National Ambulance Fee Schedule has been implemented are:

1. The new reimbursement fees with the corresponding phase-in reimbursement transition. 2. Mandatory acceptance of assignment by ALL providers. 3. Use of the new HCPCS codes for mileage. 4. Payment for an ALS response with no ALS procedures provided at the BLS reimbursement rate.

The reason for the delay in the implementation of the new National Ambulance Fee Schedule is that after reviewing and responding to the comments received on the proposed new National Ambulance Fee Schedule, HCFA must publish a FINAL RULE thirty days before implementation. HCFA is currently reviewing and responding to comments received on the new fee schedule that reportedly number in the tens of thousands. This is the reason that the scheduled date for implementation was delayed and a new implementation date has yet to be determined.

NEW CATEGORIES AND HCPCS CODES FOR KENTUCKY AMBULANCE PROVIDERS

A. BASIC LIFE SUPPORT (BLS) TRANSPORTS

A0428 BLS Non-Emergency Transport with mileage and disposable supplies separately billed 1. Replaces old HCPCS codes A0360 and A0320

A0429 BLS Emergency Transport with mileage and disposable supplies billed separately 1. Replaces old HCPCS codes A0362 and A0322

B. ADVANCED LIFE SUPPORT (ALS) TRANSPORTS

A0426 ALS Non-Emergency Transport with specialized ALS services rendered, supplies included and mileage billed separately. 1. Replaces old HCPCS codes A0326

A0427 ALS Emergency Transport with specialized ALS services rendered, supplies included and mileage separately billed. 1. Replaces old HCPCS code A0330

REMEMBER TO USE THE OLD HCPCS CODE FOR THE APPROPRIATE ALS OR BLS MILEAGE. DO NOT USE THE NEW HCPCS MILEAGE CODE!

The correct HCPCS codes for mileage is:

A0380 BLS mileage code

A0390 ALS mileage code

A0888 Non-Covered mileage

DUMMY ICD-9 CODE FOR AMBULANCE PROVIDERS

At the request of providers, effective February 13, 2001 AdminaStar will allow the use of AMB (all upper case letters) in the place of the ICD-9 code on electronic claim submissions in order to insure that the submitted claim will pass the initial electronic audit.

CLAIMS SUBMITTED TO MEDICARE FOR A DENIAL

Both HCFA and AdminaStar understand that on occasion, claims that providers recognize as non-covered services must be submitted to AdminaStar to obtain a denial so that the claim, with the Medicare denial, can be forwarded to other third party payers or private payees for payment.

At the request of ambulance providers, HCFA and AdminaStar have allowed the use of the GX modifier to tell the claims processing system not to pay the claim. Since fewer claims are now being reviewed manually, there is the possibility that providers, who only utilize the notebook section of the claim to request that the claim NOT be paid, may still have that claim paid. Both AdminaStar and HCFA want to reiterate the importance of providers using the GX modifier for all claims that are submitted to AdminaStar to obtain a denial.

CONTACTS WITH ADMINASTAR'S TELEPHONE REPRESENTATIVES

In an effort to identify and resolve the communication of any misinformation, HCFA has asked that ambulance providers who contact AdminaStar's telephone representatives document the date, time and name of the person to whom they spoke and/or obtained information. In addition, HCFA advises that in the event that the provider questions the accuracy of the information obtained from AdminaStar's telephone representative, the provider has the right to ask to speak to an AdminaStar supervisor for a clarification.

Providers who have received misinformation from AdminaStar's telephone representatives should report the instance to Lindy Lady in Part B Provider Relations at AdminaStar-Federal to prevent any further communication of misinformation to other providers. Lindy Lady's telephone number is (502) 423-2292

ROUND TRIPS - MODIFIERS

Effective February 12, 2001, AdminaStar's claims processors have been instructed not to deny claims with the YW action code when the Base or Mileage code is missing on the claim.

Example: A0428RH A0380RH - 40 miles A0428HR

AdminaStar will assume that the mileage submitted on the initial transport claim represents the total mileage for the round trip.

Until April 1, 2001, if ambulance providers submit the modifier ZG which represents a round trip, AdminaStar will process accordingly --- regardless of whether a specific Origin/Destination modifier is submitted in conjunction with the ZG modifier. After April 1st the ZG modifier will not be used.

Example: A0428RH A0380RH - 40 miles A0428ZG

Until April 1, 2001, AdminaStar will allow the A0428ZG and process as a return trip, even though the ambulance provider did not submit the modifier HR. After April 1st this will not be allowed by AdminaStar.

In addition, AdminaStar's claims processor's have been advised to check claims for indications of a round trip with only one line of mileage submitted. If that occurs, they will divide the total number of miles submitted by two to determine if the mileage per each run is greater than 40 miles. If the mileage per run is greater than 40 miles, the claim processors will apply the "nearest appropriate facility" guidelines to the claim in order to determine payment eligibility.

ROUND TRIPS - ZIP CODES AND CLAIMS

AdminaStar has advised that round trips may be reported on the same claim for a beneficiary if all points of pick-up/origination have the same zip code.

If the points of pick-up/origination are located in different zip codes, the ambulance provider MUST submit a separate claim for each trip.

Claims submitted to AdminaStar without a zip code in item 23, or with multiple zip codes in item 23 will be returned to the provider as "unable to process." AdminaStar will use message N53 on the EOMB in conjunction with reason code 16.

MAILING ADDRESS FOR HCFA 855 PROVIDER ENROLLMENT FORMS:

Per AdminaStar, the most current address to mail the HCFA 855 Provider Enrollment Forms is:

Provider Enrollment P.O. Box 37630 Louisville, KY 40233-7630

ADDITIONAL INFORMATION

As new and updated information is released from HCFA on the New National Ambulance Fee Schedule it is imperative that providers keep abreast of the information and coming changes. Two excellent web sites for additional information and document downloads are:

Tom Scott's web site: http://members.home.com/tomscott/ This site is frequently updated and contains volumes of Medicare information for ambulance providers.

HCFA's web site: http://www.hcfa.gov/medlearn/refamb.htm This site contains an excellent question and answer section on the New National Ambulance Fee Schedule. Providers are reminded to periodically revisit this question and answer section as it is a "work in progress" due to the fact that the FINAL RULE has not been published. This site also contains the training manuals for HCFA's carriers and intermediaries on how they are to implement the New National Ambulance Fee Schedule. The training manuals can be downloaded and printed for easy reference.