Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1003 Date: November 25, 2011

Transcription

1 anual ystem Pub One-Time Notification Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 1003 Date: November 25, 2011 hange equest 7489 Transmittal 942, dated ugust 5, 2011, is being rescinded and replaced by Transmittal 1003, dated November 25, 2011 to include additional instructions for the maintainer. ll other information remains the same. UBJET: nstructions to ccept and Process ll mbulance Transportation ealthcare ommon Procedure oding ystem (P) odes. UY O NGE: This instructs contractors to revise their claims processing systems in order to allow P codes identifying edicare statutorily excluded (or otherwise not payable by edicare) ambulance transportation and transportation related services into their systems for adjudication and to deny claims for such services as "non-covered" services. EETVE DTE: January 1, 2012 PLEENTTON DTE: January 3, 2012 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED-Only One Per ow. /N/D N/ PTE / ETON / UBETON / TTLE. UNDNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s) and/or arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

2 V. TTENT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

3 ttachment One-Time Notification Pub Transmittal: 1003 Date: November 25, 2011 hange equest: 7489 Transmittal 942, dated ugust 5, 2011, is being rescinded and replaced by Transmittal 1003, dated November 25, 2011 to include additional instructions for the maintainer. ll other information remains the same. UBJET: nstructions to ccept and Process ll mbulance Transportation ealthcare ommon Procedure oding ystem (P) odes Effective Date: January 1, 2012 mplementation Date: January 3, GENEL NOTON. Background: ertain P codes identify various transportation and transportation related services that are statutorily excluded from edicare coverage and, therefore, are not payable when billed to edicare. ll P codes contained in the edicare Physician ee chedule Database (PDB) have status indicator codes associated with them which indicate to edicare claims processing contractors such things as which P codes are ctive, ontractor Priced, Local odes, Bundled/Excluded, etc. These P codes identifying various transportation and transportation related services that are statutorily excluded from edicare coverage have a status indicator of or X associated with them. n the enters for edicare and edicaid ervices () nternet Only anual (O) Publication , hapter 23 ee chedule dministration and oding equirements, PDB tatus ndicators, the status indicator code is defined as Not valid for edicare purposes. edicare uses another code for reporting of, and payment for, these services while the X status indicator code is defined as tatutory Exclusion. Because P codes are valid codes under the ealth nsurance Portability and ccountability ct (P), claims for ambulance transportation and transportation related services (P codes 0021 through 0424 and 0998) which are statutorily excluded or otherwise not payable by edicare should be allowed into the edicare claims processing system for adjudication and, since these services are statutorily excluded from, or otherwise not payable by, edicare, then rejected or denied as such. Doing so affords providers and suppliers submitting the claims on behalf of edicare beneficiaries the opportunity to submit no-pay claims to edicare for statutorily excluded or otherwise not payable by edicare services with the P code that accurately identifies the service that was furnished to the edicare beneficiary. Doing so will allow providers/suppliers to obtain a edicare denial to submit to a beneficiary s secondary insurance for coordination of benefits purposes. B. Policy: ontractors shall revise their claims processing systems in order to allow P codes identifying edicare statutorily excluded ambulance transportation and transportation related services into their systems for adjudication. laims containing these statutorily excluded ambulance transportation and transportation related service codes shall be rejected or denied as statutorily excluded. Those providers/suppliers wishing to bill for statutorily excluded ambulance transportation and transportation related services in order to obtain a edicare denial shall bill for such services by attaching the GY modifier to the P code identifying the service according to long-standing policy.

4 . BUNE EQUEENT TBLE hall" denotes a mandatory requirement Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers ontractors shall accept into their systems the range of P codes 0021 through 0424 and 0998 (while continuing to accept those P codes included in the mbulance ee chedule) ontractors shall reject () or deny () claims for services (individual claim lines) containing the P codes 0021 through 0424 and ontractors shall use the following remittance advice language when rejecting () or denying () these statutorily excluded services: laim djustment eason ode -96 Non-covered charge(s). emittance dvice emark ode -N425 tatutorily excluded service(s). E V W Group ode -P Patient esponsibility ontractors shall use the following N message when rejecting () or denying () these statutorily excluded services: "edicare does not pay for this item or service. O edicare no paga por este artículo o servicio ontractors shall apply the instructions above to claims received on or after January 1, 2012 as long as the claims are received within the proper timely filing deadline. X X X

5 . POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. X E X X V W V. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: N/ "hould" denotes a recommendation. X-ef equirement Number ecommendations or other supporting information: ection B: or all other recommendations and supporting information, use this space: N/ V. ONTT Pre-mplementation ontact(s): ontact Eric oulson at eric.coulson@cms.hhs.gov or (410)

6 Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable. V. UNDNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.