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Elizabeth M. Whitehorn, Director

SMART Act Ambulance Services

Problem:

As a result of an administrative rule change, the reimbursement rates to ambulance providers were changed effective with dates of service 07/01/13. In addition, the SMART Act 2.7% reimbursement rate reduction no longer applies to ambulance services. Since the rule affected reimbursements already made to providers for dates of service back to 07/01/13, HFS has underpaid providers.

Providers Impacted:

Ambulance Service Providers

Procedure Codes Impacted:

A0422, A0425, A0426, A0427, A0428, A0429, A0431, A0431 (H), A0433, A0434

Problem Begin Date:

Claims with dates of service on or after 07/01/13

Problem Fix Date:

Claims received on and after April 9, 2014 for dates of service on or after 7/1/13

Resolution for Impacted Claims:

Approximately 300K claims with dates of service on or after July 1, 2013 will be adjusted as a result of the rate increase. The department is processing the adjustments in batches as some of the claims require additional review.

The first batch of adjustments includes approximately 217K claims that will be completed by June 30, 2014. The first batch of adjustments includes:

  • All emergency claims billed under category of service 50 with procedure codes A0422, A0425, A0427, A0429, A0433, A0434 and with less than 10 miles billed

  • All emergency electronic claims billed under category of service 50 with procedure codes A0422, A0425, A0427, A0429, A0433, A0434 and with less than 100 miles billed

  • Rotary Wing claims billed under category of service 50 with procedure codes

    A0431 and A0431 (H)

In the process of researching which claims to adjust, some claims were found to be overpaid on mileage code, A0425. The department continues to research the problem. Two problems with processing claims have been identified:

  • Paper claims that were billed with a decimal were inaccurately scanned. For example, a claim billed with a quantity of 67.3 miles was read by the scanner as 673 miles. Per the instructions on how to complete the HFS 2209, Transportation Invoice, providers should round up to the nearest mile when billing miles. Decimals should not be used when billing. The system has been changed to edit for decimals.

  • Inaccurate miles were reported on emergency claims that did not require prior approval. HFS reminds providers who use a vendor that miles are reported in CR106 with a qualifier of DH. If loop 2300, CR106 is populated, the quantity will be applied to each service line including the base rate unless overridden at the line level, loop 2400. The base rate should always be a quantity of one at the service line level.

The department continues to work through remaining claims with category of service 50 and 51. All providers should verify their mileage. Please continue to access this site for updated announcements.