Effective April 1, 2001, AdminaStar-Federal standardized the Medicare Part B claims processing system for Medicare Part B providers in both Kentucky and Indiana. The changes that have effected Ambulance Providers in the state of Kentucky are as follows:

Kentucky Ambulance Providers SHOULD NOT USE the following local Medical Necessity modifiers because they are INVALID.

XB - Bedridden

XD - Patient needs to be restrained

XE - Patient is unconscious or in shock

XG - Patient must remain immobile because of fracture/suspected fracture

XH - Patient can be moved by stretcher only

XI - Patient is experiencing stroke or myocardial infarction symptoms

XJ - Patient is experiencing severe hemorrhage

XL - No bed available at the first hospital

XM - Patient admitted to second hospital for test/surgery that could not be performed at first hospital

XO - Transport to an approved dialysis center

Specific information, (NOT CODES), documenting the medical necessity for the ambulance transportation MUST be included in the notepad/narrative section of ALL Medicare claims.

All providers MUST continue to use the HCFA National Modifiers to indicate the ORIGIN and DESTINATION. These modifiers are:

D - Diagnostic therapeutic site other than Physician's office/Hospital

E - Nursing Home

G - Hospital-based dialysis facility (Hospital or Hospital related)

H - Hospital

I - Site of transfer, i.e. Airport, Helicopter pad, between modes of Ambulance transport, etc.

J - Non-hospital

N - Skilled nursing facility

P - Physician's office

R - Patient's residence

S - Scene of accident or acute event

X - Physician's office to hospital

Due to Provider confusion about the discontinuation of the local Medical Necessity modifiers, AdminaStar-Federal has not denied claims received with the discontinued modifiers, but rather has issued development letters to the providers requiring deletion of the discontinued modifiers. Providers have then been required to return the development letters with the appropriate action back to AdminaStar. Upon receipt of the returned development letters, AdminaStar has then released the claims for processing.

Effective August 1, 2001, at the request of KAPA and in response to a significant number of Ambulance Provider's claims being suspended for development, AdminaStar-Federal has agreed to process all submitted Medicare claims with or without the discontinued local Medical Necessity modifiers until September 1, 2001.

Providers who have received development letters due to the use of local Medical Necessity modifiers will NOT have to send the letters back to AdminaStar. AdminaStar has agreed to release all of these claims for processing until September 1, 2001.

All Medicare claims received from Ambulance Providers AFTER September 1, 2001 using the local Medical Necessity modifiers will have the processing of the submitted claim(s) suspended and will receive a development letter for each claim(s). The Ambulance Provider will then be required to make the appropriate correction for each claim and then return the development letter to AdminaStar before the claim will be released for processing.