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 Congress to Decide on 2013 Fee Schedule
December is a busy month as we wrap up our projects for 2012 and prepare for 2013. One of the big questions is the Medicare fee schedule and what we can expect for payments next year. While Congress has not yet set the rates, there are some clues to the items being considered for ambulance providers and suppliers.
The Medicare Payment Advisory Commission (MedPAC) was tasked by Congress to evaluate ambulance payments and delivered a report in November. The report had recommendations in two areas.
Recommendation 1: Fee schedule
- Allow the three temporary ambulance add-on policies to expire; (These are the urban, rural and super-rural bonuses.)
- Rebalance the relative values of ambulance services by lowering the relative value of BLS non-emergency services and increasing other levels of service.
- Allow the rural mileage bonus to expire and replace it with increased payments for ground transports from geographically isolated, low volume areas.
Recommendation 2: Program integrity and fraud
- Develop national guidelines to define medical necessity.
- Develop a process for screening claims for medical necessity.
- Identify and address clinically inappropriate use of BLS non-emergency transports.
Congress does not have to accept these recommendations, but on the surface, the recommendations are trending toward a reduction in payments. In addition to the recommendations, Congress must also apply formulas to the fee schedule using the Consumer Price Index, which has been trending upwards. Mix all these factors together with the current economic and political landscape and it's difficult to see the direction this will take. So stay tuned- as information becomes available, we will keep you updated. |
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 EMS Data Interchange (EDI) Updates
ANSI 5010 * ICD-10 * NEMSIS v3
In the technology world of EMS reporting and billing, there are three common information interchange standards that are used.
- ANSI 5010 - This is the HIPAA-approved electronic format for exchanging medical information such as claims and payments. The standard was updated in January 2012 from the previous 4010 version.
- ICD codes - For outpatient billing, ICD codes are the diagnosis codes that are attached to claims. ICD-9 is the current version and it is scheduled to be replaced in October 2014 by ICD-10.
- NEMSIS v3 -The NEMSIS file format is used to report EMS data to state and federal entities as well as submit information to many EMS billing applications. This standard is also updating to v3 in 2014.
New versions of these standards are constantly on the drawing board to keep current with changes in treatment and information requirements. As each of these standards is updated, it goes through a development and initial testing process, usually taking 1-2 years based on input from various stakeholders. This is followed by a phase-in period of 1-2 years, where both the old and new standards are compatible. Finally the old standard is discontinued and only the new standard is accepted.
From a timeline stand point, a change in one standard can affect another standard. For instance, the ANSI version had to be updated to 5010 in order to support the expanded format of ICD-10. Concurrent with these changes, the NEMSIS update has also been progressing.
Rest assured that your EMS software vendors as well as our billing software are on top of these updates. ESO is releasing their new Web version 4.8, which is fully NEMSIS v3 compatible, later this month. Zoll and ImageTrend (WEMSIS) also report being on track for full compatibility shortly. Our billing software has been ICD-10 compliant since our shift to 5010 this past January and our ongoing NEMSIS v3 development is being finalized to incorporate the latest NEMSIS v3.3 standard just being released. These changes implement nationwide in a very controlled fashion over a period of time to minimize interruption in claims processing and payment.
If you have any questions or concerns don't hesitate to contact us or your software vendor directly. |
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 Attorney Requests: Do Not Utilize Web Access for Patient Account Histories
Systems Design clients are now able to log in through our website to search patient accounts, acquire financial reports, etc. There is something we need to ask you not to do with this feature: please DO NOT respond to attorney requests for billing information with an account history from our web site. If a balance has been written off to a levy program or as uncollectable, the account history will reflect a zero balance. If this is sent to an attorney, we may miss out on settlement funds. Please refer attorney requests to us and we will provide a document reflecting the original balance.
We actually recover quite a few dollars from settlements, so it's always worth letting us process your attorney requests. We will make sure it's handled in a way that maximizes your revenue potential. |
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 Medical Record Number (MRN) Acquisition
Many of our clients acquire MRNs (Medical Record Numbers) from the hospital when they deliver a patient. This number is very useful to us and could help improve your bottom line.
When Systems Design requests patient insurance information from the hospital we typically provide the patient's name, date of birth and social security number. When this information does not align exactly with what the hospital has on file, they return the request stating "no such patient". If we supply the MRN, the hospital can locate the patient and provide any insurance information.
Most ePCR applications have a field for the number, or it can be added to the narrative. For software application questions please contact our IT dept. If your organization documents on paper, please include the MRN if possible and we will use it in our request. |
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 Revalidation Update
A big thank you to all FD staff who provided information needed to get your revalidations submitted to Medicare within the deadline! As we wrap up the final submissions and move on through further stages of the process, we'd like to offer some information on what to expect next.
To see Medicare's description of the enrollment process, click here: https://www.noridianmedicare.com/partb/enroll/
From our recent experience, here's how those steps work out for you:
2nd Stage: Once your revalidation is received, Medicare compares the data currently in your file to what was submitted with the revalidation paperwork. Since the entry of the new data essentially overwrites the old data, they are emailing us with questions about the older data to ensure that it is safe to delete. As we contact you with these questions, please respond as quickly as possible, since these requests have a suggested 10-day deadline.
3rd Stage: After Medicare has confirmed that the paper portion of your revalidation is correct, your application will be put in queue for a Site Visit to all the locations that were entered on the revalidation paperwork. The Site Visit is a brief physical confirmation that the locations listed are occupied by your agency and equipped to do the type of work for which you are enrolling. For more info about the Site Visit process, click here: https://www.noridianmedicare.com/shared/partb/bulletins/2012/278_may/CMS_Fraud_Prevention_-_Automated_Provider_Screening_and_National_Site_Visit_Initiatives.htm
4th Stage: We will be following the progress of all our clients' revalidations until such time as we receive the confirmation letter that says the revalidation is complete. If the letter comes to us, we will forward you a copy for your records. If your payments are routed to your address instead of ours, please be sure to forward a copy of this letter to us, so we'll know that the process is completed.
Our next newsletter will feature an article on keeping your Medicare file updated.
Again, thanks to everyone involved in the revalidation process for keeping a level head and a good attitude so that the process could be completed effectively. |
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 Claims Review Notification
When enrolling with Medicare, most providers have one address for their administrative office and another address for their payments. Most correspondence goes to the payment address but occasionally, important notices are sent directly to the provider's administrative offices.
Two important notices which are sent directly to the provider come from companies contracted by Medicare to perform the CERT audits and the RAC audits. Below are links to examples of these letters:
CERT Audits:
https://www.certprovider.com/Sample_Letters/Part_B/Part_B_Initial_EN.pdf
RAC Audits:
https://racinfo.healthdatainsights.com/Public1/Forms/FinalAutomatedDemandLetter.pdf
The CERT audits randomly select paid claims and review the medical record for improper payments, both overpayments and underpayments. The RAC audits focus on three specific items for ambulance claims:
- Payments made for a transport during a hospital stay.
- Payments made for more than one transport per day.
- Payments made for transports from one skilled nursing facility to another.
If you receive either of these notices, please let us know so we can start gathering the records. Each claim audit will have a deadline and if the records are not submitted, any amount previously paid will be taken back. Because these audits request the "full medical record", we will contact you for any additional records you have which were not needed for billing. |
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We welcome suggestions of topics of interest for future newsletters. Please contact our Client Services Coordinator at 360.394.7028 or email EllenR@SDWems.com. |
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 Year End Tips
End of the year Batches
As we move into 2013, please review your transport billing batches for dates of service. If you have transports for both 2012 and 2013, please create separate batches for each year.
Year-End Reports
If you need any special year-end reports, please give our staff as much notice as possible so we have time to make them suit your needs perfectly.
Holiday Hours
Systems Design will be closed on December 25th and January 1st. |
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Quick Links | |
Maybe you missed an earlier newsletter, or want to refer back. Just click the link below to view our Newsletter Archive page.
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Systems Design Wishes You
a Safe and Happy Holiday Season! |
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Administration
Toll Free: 800-585-5242
Phone: 360-394-7020
Fax: 360-394-7099 |
info@sdwems.com |
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