Medicare Fee Update

AK-EMS: Special Mileage Rules

Documentation & Reimbursement

NW Volunteers 

With the recent tragedy in Japan, many NW volunteers were mobilized.  One of those organizations is IMAT, the International Medical Assistance Team.  IMAT is a non-governmental organization founded by Snohomish County Paramedic Chris Tompkins after the earthquake in Haiti last year.  It provides on-the-ground medical assistance to areas in need. 

For more information or to volunteer visit their website:

www.IMATeam.org

Thank you for having the expertise and passion to extend humanitarian medical aid outside our borders!

HIPAA Bottom Line 

There's one message Dena Boggan, CPC, CMC, CCP, a privacy and security officer in Mississippi, wants to get across during her HIPAA training: "I tell my employees if they don't remember anything else about HIPAA, remember this - only access that information which you need to do your job. Period. I tell them if they follow that one simple rule, they'll do just fine."

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Documentation & Reimbursement 

Part 2: Medical Necessity

Medicare patients make up a substantial portion of ambulance transports so it is important to understand their documentation requirements. One of the big requirements to receive payment from Medicare is that transports must be "medically necessary". How Medicare defines medical necessity is narrower than most of us would think. The fact that someone called 911 does not make a transport medically necessary and does not guarantee payment.

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Next month's documentation topic, Destinations. 

Medicare File Hygiene 

For any medical services provider, the ability to bill Medicare is one of the foremost financial considerations in funding operations.  Many of our clients ultimately bill anywhere from 40-70% of their transports to a Medicare plan.  After the original enrollment is completed, the Medicare application process often becomes a distant, slightly painful memory, and maintaining correct information in your provider file is low on the priority list as long as the payments keep coming in.  However, in this era of increasing scrutiny for fraudulent billing, including site visits to provider's address of record by Medicare contractors, we are recommending that our clients develop a process to review the information contained in their Medicare provider file to ensure that any changes get properly reported to Medicare.   The expectation by Medicare is contained in the quote below, which is taken directly off of a recent award letter to a new provider.

 
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EFT Payment Logistics

 Part of the Debt Collection Improvement Act of 1996 mandated that all Federal payers make their payments via EFT (electronic funds transfer) to save the costs of printing and mailing checks. Fortunately, this was not put into place immediately, but has been phasing in over the last 15 years, as Medicare has required all new providers and those making updates to their files to enroll to receive EFTs. There are very few providers who are still receiving paper checks from Medicare. EFTs have also been available with other Federal payers, like the VA, Railroad Medicare or Federal Corrections Facilities, but have been optional up to this point. We have received word from the VA that 2011 is the last year that EFT enrollment will be optional with them, and they will be pushing to get any stragglers enrolled before the end of the year. One reason that we have not aggressively pushed our clients in this direction is the large number of clients who share their County's bank account with other medical providers, which causes a fair amount of consternation with the County Treasurer when an unidentified EFT arrives.

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