Beginner’s Guideline For Ambulance Transportation Billing

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Beginners Guideline For Ambulance Transportation
Billing

• Ambulance transportation is one of the most
  highly-priced services provided by the US
  healthcare and paid by Medicare. So its
  important that the Ambulance transportation
  service providers understand the basic guideline
  of ambulance transportation billing.
• Ambulance services are covered under Medicare
  Part B, this service is available for the
  Medicare beneficiary only if the following
  required conditions are met
• Actual Transportation Of Beneficiary Occurs In
  The Condition.
• The Beneficiary Is Transported To An Appropriate
  Destination.
• The Condition Of The Beneficiary Should Be Such
  That Other Modes Of Transportation Could Prove
  Fatal.
• The Provider Should Meet All The Necessary
  Criteria For Example Vehicle, Staffing, Equipment
  For Transportation.
• The Transportation Will Never Be A Part Of
  Medicare Part A Service.
•  
• Definition Of Implementation
• A/B MAC (A) Definition This refers to those
  contractors that process the claims for
  institutionally based ASC claim transactions or
  Form CMS-1450. 

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Beginners Guideline For Ambulance Transportation
Billing
A/B MAC (B) Definition The term refers to those
contractors that process claims for ambulance
suppliers billed on the ASC X12 837professional
claim transaction or a CMS-1500 form. (Note the
above definition refer only to the
chapter) Ambulance Services are separately
reimbursable only under Medicare Part B. Once the
beneficiary is admitted to a Critical Access
Hospitals (CAH) or Skilled Nursing Facility (SNF)
it might be necessary for the transport of
beneficiary to the other specialized hospital.
During the whole process, the beneficiary does
maintain the inpatient status for the original
provider.   The transportation of such condition
is considered as an inpatient hospital. For CAH
it comes under Part A and for an SNF service, it
is covered in the SNF service with Part A payment
for the service.  The service is covered and
payable under beneficiary transportation service
under Part A, the service cannot be shifted under
part B. Intra-campus transfer are not payable
under Part-B. Such intra-campus transfer cost is
accounted in the same manner as the cost of the
single building. The A/B MAC (A) is responsible
for claim processing of ambulance services which
is furnished by a
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Beginners Guideline For Ambulance Transportation
Billing

• hospital-based ambulance or for ambulance
  services provided by a supplier if provided by
  the supplier under the arrangements for an
  inpatient. The A/B MAC (B) is responsible for
  processing claim for suppliers for the entities
  that are not owned or operated by a provider.
• Payment Rules For Ambulance Transportation
  Billing
• Medicare-covered ambulance services are paid
  according to the Medicare Ambulance fee schedule.
  The below following sections provide an insight
  how the payment amount is calculated for
  ambulance transportation
• Should Have A Separate Base Payment And Payment
  For Mileage.
• The Services Provider Should Cover The
  Beneficiary To Nearest Facility And All Items,
  Services Associated With Transportation.
• Should Not Include Separate Payment For Items
  Used And Service Under The Ambulance Benefit.
• For items and services, we have to include the
  fee schedule payment. Such items and services
  include everything but are not limited any object
  or service. They are both medically necessary and
  covered by Medicare under ambulance benefit. 

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Beginners Guideline For Ambulance Transportation
Billing

• Components Of Ambulance Fee Schedule
• For Ground Ambulance Service
• A Money Amount That Serves A National Uniform
  Base Rate Is Called As A Conversion Factor For
  All Ground Ambulance Services.
• Relative Value Unit (RUV) Assigned To Each Ground
  Ambulance Service.
• A Geographic Adjustment Factor (GAF) For Each
  Ambulance Fee Schedule Locality Area.
• An Additional Amount Of Certain Mileage For Rural
  Point-Of-Pickup.
• For Air Ambulance Service
• A Uniform Base Rate For The Wing And Nationally
  Base Rate For Rotary Wing.
• Geographic Adjustment Factor (GAF) For Each
  Ambulance Fee Schedule Locality Area.
• A Uniform Loaded Mileage Rate For The Air
  Service.
• An Adjustment Base Rate And Mileage For Rural
  Point Of Use.

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Beginners Guideline For Ambulance Transportation
Billing

• For Claims Outside U.S.
• Ground transport that drops off and picks up
  patients within Canada or Mexico will be paid
  according to the closest U.S. Zip Code.
• In case of water transport, the fee would be paid
  according to the port of entry for the U.S.
• For those providers which make an entry.
• Ground transports with pickup and drop off points
  within Canada or Mexico will be paid at the fee
  associated with the U.S. ZIP Code that is closest
  to the POP.
• Modifiers For The Ambulance Claim
• The origin and destination of modifiers for the
  ambulance services are created by combining two
  widely different alpha characters. Each of the
  alpha characters starts with an exception of X to
  represent origin code or destination code. The
  first position of alpha code equals origin and in
  the second position of alpha code equals
  destination.
• Origin And Destination Codes And Their
  Descriptions Are Listed Below

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Beginners Guideline For Ambulance Transportation
Billing
D  Diagnostic or Therapeutic Site Other Than P
or H When These Are Used As Origin Codes E 
Residential, Domiciliary, Custodial Facility
(Other Than 1819 Facility) G  Hospital Based
ESRD Facility H  Hospital I  Site Of Transfer
(E.G. Airport or Helicopter Pad) Between Modes Of
Ambulance Transport J  Freestanding ESRD
Facility N  Skilled Nursing Facility P 
Physicians Office R  Residence S  Scene of
Accident or Acute Event X  Intermediate Stop At
Physicians Office On Way To Hospital
(Destination Code Only) Exploring the
intricacies of Ambulance Billing is just the
beginning. For a comprehensive understanding of
the guidelines, delve into how our expert Medical
Billers and Coders handle Ambulance
Transportation billing. Visit our website or
reach out to us at 888-375-3226.