Ambulance Billing Best Practices for Healthcare Providers
Resource to educate service providers on proper ambulance billing to reduce duplicate encounters. Covers submitting multiple trips, homeless patient services, modifiers, and X12.837 data requirements.
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Simplifying Healthcare Administration AMBULANCE BILLING BEST PRACTICES Created by HICE Encounters Standardization Team JUNE 2023
INTRODUCTION Overview: This document is intended to be a resource to help educate service providers on proper claims submissions for ambulance billing to reduce duplicate encounter submissions. How-to-use: As a resource/training tool to educate on proper claims submission for ambulance services, including multiple trips and homeless patients Audience: All health care organizations, such as health plans, provider organizations and delegates that work with claims or encounters for ambulance billing; service providers Use cases: The Ambulance Billing Best Practice is intended to provide clear and consistent guidance for various scenarios that occur with ambulance services. This presentation is designed to be a quick tool and resource for health care organizations to use when coding encounters. 2 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
TABLE OF CONTENTS 1. Introduction / overview / use cases / audience 2. Submitting multiple trips for ambulance services in the same day / use of modifiers / X12 837 data showing for multiple trips / 3. X12 837 mapping requirement on ambulance transport 4. Direct Medi-Cal FFS ambulance claim example 5. Guidance on submitting homeless ambulance transportation services 6. Sources 7. HICE Resources 3 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
GUIDANCE ON SUBMITTING AMBULANCE TRANSPORTATION SERVICES WHEN 3 TRIPS OCCUR ON THE SAME DAY When submitting multiple trips for the same date of service the origin/destination modifier must be used for identifying the point of origin and the destination. The first digit modifier indicates the point of origin, and the second digit modifier indicates the destination. Any repeat Ambulance HCPCS codes billed for the same date of service will require a unique modifier to avoid duplicates. Modifier 76 indicates a repeat service was performed on the same day after the original service. Modifier 59 is to identify the procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. 4 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
X12 837 DATA SHOWING FOR MULTIPLE TRIPS 5 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
X12 837 MAPPING REQUIREMENT ON AMBULANCE TRANSPORT - REQUIRED FIELDS WHEN CR1 IS ADDED TO ANSI 5010 837 RECORD (USAGE IS SITUATIONAL BASED ON PAYER REQUIREMENTS) CR104 AMBULANCE TRANSPORT REASON CODE CR105 UNIT OR BASIS FOR MEASUREMENT CODE DH FOR MILES CR106 QUANTITY. 0 CAN BE USED WHEN AMBULANCE SERVICES DO NOT INCLUDE A CHARGE FOR MILEAGE 6 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
DIRECT MEDI-CAL FFS AMBULANCE CLAIM EXAMPLE FOR MULTIPLE TRIPS Example when you have 2 transports on one day. First claim has 15 miles, second claim has 10 miles If multiple trips for the same recipient are provided on the same date of service, enter the time of day and the points of destination in the Additional Claim Information field (Box 19) of the CMS-1500 claim. Without this information, second and subsequent trips may be denied as duplicate services. When billing round-trips, transportations must be documented with the time of day and points of destination in the Additional Claim Information field (Box 19) of the CMS-1500 claim form. Enter the appropriate response to call procedure code: 1. On one billing line, showing a 2 in the Days or Units field (Box 24G) and one charge for this portion of the service, or 2. On two billing lines, showing a 1 in the Days or Units field (Box 24G) with a charge for each individual leg of the service, or 3. On two separate claims, showing a 1 in the Days or Units field (Box 24G) with a charge for the individual leg of the service (illustrated below) 4. On Box 19, Reason code can be submitted, for example Reason code A 7 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
GUIDANCE: HOW TO SUBMIT HOMELESS AMBULANCE TRANSPORTATION SERVICES How to identify last known location using N302 segment when a member is homeless and picked up on the street 8 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
EXAMPLE: X12 837 HOMELESS AMBULANCE SERVICE How to identify last known location using N302 segment when a member is homeless and picked up on the street 9 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
GUIDANCE: HOW TO SUBMIT HOMELESS AMBULANCE TRANSPORTATION SERVICES How to identify where homeless member was picked up if address or cross streets are available* using either NTE field OR N302 segment (N302 segment is preferred but if there are system limitations use the NTE segment to report) 10 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
EXAMPLE: X12 837 HOMELESS AMBULANCE SERVICE How to identify where homeless member was picked up if address or cross streets are available* using either NTE field OR N302 segment (N302 segment is preferred but if there are system limitations use the NTE segment to report) * If there are no cross streets or address available, NTE field or N302 segment is not needed 11 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
DEFINITIONS OF REFERENCED FIELDS N302 segment 12 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
DEFINITIONS OF REFERENCED FIELDS NTE field 13 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
SOURCES Origin and Destination Modifiers (CMS) Medical Transportation Ground Information (DHCS) 14 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
HICE RESOURCES HICE Encounters Standardization Team HICE Encounters Standardization Team Documents HICE Team Folders Working Documents: Materials Library Approved HICE Documents - Best Practices and Additional Resources Questions about this document? Contact: admin@iceforhealth.org 15 Prepared as part of IHA s Encounter Data Improvement program. Learn more at IHA s Encounter Data Resource Hub
