RSS URL
| Start Page | > | About Ortivus | > | News | > | 20051115 |
News release
11/15/2005
Ambulance Fee Schedule 2006
The first phase of what once seemed like an eternal process is quickly coming to an end - the initial phase-in period of the Ambulance Fee Schedule (AFS). This brings with it tremendous simplification in some areas, and challenging decisions to be made in others. The three issues to address include: The “Blending Formula” for your allowed amounts, Method 4 vs. Method 2 Billing, and The “Q-Codes”.
“Blending Formula”:
As of January 1, 2006, all Ambulance reimbursement will be based 100% on the AFS, instead of a blend of the old payment methodology and the AFS. The AFS is still a blend of the National Fee Schedule and one of nine Regional Fee Schedules until December 31, 2009. What this means for Sweet-Billing users is that it will no longer be necessary to update entries in your “Charge Code”, “Payor Overrides”, “Allowable” fields for Medicare. Medicare Allowed Amounts will be calculated solely on the entries in “Utilities”, “Database System Setup”, “Fee Schedule 2 – 4” tabs. These are the tabs for entering the amounts for the National Fee Schedule, and your respective Regional Fee Schedule.
Method 4 vs. Method 2 Billing:
(If you are already billing all Payors ‘Method 2’, as many are, skip this paragraph)
Method 4 Billing is no longer allowed for Medicare as of January 1, 2006. In other words, no longer can supplies and ancillary charges be billed separately. Medicare must be billed a Base Rate, and Mileage charge only. The next question commonly asked is “Can I bill Medicare ‘Method 2’ and bill Commercial Insurance ‘Method 4’?”. Technically, yes. However, carefully consider the possible repercussions. There has been a trend on the part of Commercial Insurers to mirror what Medicare does, especially if it is financially beneficial to them. It seems reasonable that Commercial Insurers will soon (if they have not already) be advised by their consultants that it would be in their best interest to declare A0427 (and all the other Base Rate HCPCS) an “all inclusive code” “per Medicare’s guidelines”. IF they do that, there would be no reimbursement for ancillary charges billed to them either. Furthermore, there would be limited time to react, as several week’s claims would already be in the pipeline when the problem first surfaced. Secondly, there are some Commercial Insurers that deny secondary claims if the charges on the CMS 1500 Form do not exactly match the EOMB from Medicare. In these cases a ‘Method 2’ 1500 form would have to be printed already. Thirdly, Method 2 Billing saves a lot of time in Data Entry, as well as in required documentation from the field. It also eliminates the possibility of decreased revenue due to ‘missed charges’ for supplies. Thus, from an efficiency and accuracy standpoint, it is clearly the suggested method. By taking the time now to accurately determine what your charges need to be in order to meet your revenue requirements, and moving yourself to an ‘All Method 2’ system, you take control of your own destiny and make the changes on your terms, eliminating the potential for undesirable results should outside forces beyond your control force the change at some unknown point in the future.
The “Q-Codes”:
These HCPCS, Q3019 & Q3020, have been used during the AFS phase-in period to indicate those transports where BLS level care to a BLS patient was provided by an ALS crew and vehicle. This is most often the case in jurisdictions that are “ALS Mandated”, but are also appropriate under some other circumstances. This is another provision of the AFS that is eliminated after January 1, 2006. From this date onward, when you receive a dispatch for a condition for which a BLS response is indicated, and you provide BLS level care, you must bill Medicare a BLS Base Rate, regardless of the certification level of the crew / vehicle providing the care / transport.
In closing, could any of this change? As is well known, with the Government involved, a law is only written in stone until the law that changes it comes along. We have seen the Fee Schedule change in the past, and certainly, it could change in the future. At the time of this writing, there are some moves afoot to make changes to some aspects of the AFS mentioned above, so it is clearly a good idea to keep your “ear to the ground”. If there are changes, Ortivus North America will be here to assist you in working your way through them! In the absence of new legislation however, these are the changes that you should make preparation for in 2006.
# # #
About Ortivus:
Ortivus offers integrated software solutions for Emergency Medical Services and Public Safety. The North American Subsidiary develops and markets the following pre-hospital applications: EMS billing, patient care reporting, computer-aided dispatch, automatic vehicle location, mobile data application, and patient vital signs monitoring and data transmission.
The Ortivus vision is to be the customer’s preferred provider of integrated information and decision-making software support systems in the Emergency Medical Service, Public Safety and Healthcare industries.
Ortivus operates out of two North American corporate office locations (Decorah, Iowa, US and Montreal, Quebec, Canada), as well as several international locations (Sweden, Denmark, Germany and Great Britain).