Medicare rejecting ambulance claims when 'AMB' used

By MIKE SWIFT
Kentucky Ambulance Providers Association

GLASGOW — The following Medicare ambulance billing issue has been identified by the Kentucky Ambulance Providers Association.

ISSUE
Ambulance claims are rejecting when the AMB is indicated in the diagnosis field item 21 of the CMS-1500.

In the current Medicare regulations, it states that ambulance providers are exempt from using ICD-9 codes, although the HIPAA law conflicts with this regulation. We are researching this problem further with CMS. Listed below is a temporary resolution until we can obtain further clarification.

RESOLUTION
List 999.9 in item 21 of the CMS-1500 claim form. Re-transmit the claims before the 13th, so that you may take advantage of the temporary payment floor elimination.

RESULTS
Since AMB is no longer valid, indicating 999.9 in the item 21 of the CMS-1500 form, will allow the claim to pass through the front-end edit process so that we may consider the claim for payment.

Please call Lindy Lady at (502) 329-8529 with questions, or send me a email at lindy.lady@anthem.com.

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