PET & WPS Medicare Updates
EMS Billing Services is a member of the Wisconsin Physician Services Provider Education and Training Advisory board (WPS PET) where WPS and CMS regulations and issues concerning billing are discussed. As a member representing individuals like you, we would be happy to address your unresolved concerns or issues. Please submit your question or concern to our PET Board forum and we will post the answer on this forum after the next scheduled board meeting. Click here to submit your question.
PET Minutes – April 29, 2010
Minutes for Ambulance Provider Education and Training (PET) Advisory Committee for Iowa, Kansas, Missouri and Nebraska, April 29, 2010
In attendance: EMS Billing Services, Inc., Metropolitan Ambulance Services Trust (MAST), Midwest Billing/Life team, Northland Regional Ambulance District, St. Charles County Ambulance District
HIPAA: Providers should watch the CMS and WPS websites for HIPPA updates.
Claims and Timely Filing Changes: Medicare claims must now be received by the Medicare contractor within 12 months of the date of service effective Jan. 1, 2010. For more information or for claim processing information pertaining to all providers, go to the claims page on the WPS Medicare website at: http://www.wpsmedicare.com/part_b/business/claims.shtml.
See the MLN MM 6960 at: http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf
Extension of Ambulance Add-Ons & Rural/Super Rural Increases: WPS is waiting for CMS guidance regarding handling of the change to the extension of the add-ons for rural/super rural increases. Providers should be watching the list-serv messages, WPS and CMS websites for updates as they become available.
Go Green: Providers are encouraged to sign up for EFT and use MREP as it provides a cost savings to providers as well as to the Medicare program.
Self-Service Technology: Self-service technology is available on the WPS and CMS websites and is free to providers. It includes Interactive Voice Response (IVR) and C-Snap.
Partnerships with AMB Associations members: Members should send any new membership information to Sue to keep the PET board informed.
Beneficiary Signatures: For information on beneficiary signatures, providers should refer to Code of Federal Regulations citation 42 CFR 424.36 at:
http://cfr.vlex.com/vid/424-36-signature-requirements-19805037
For the CMS IOM manual, go to: http://www.cms.gov/manuals/Downloads/bp102c10.pdf
Refer to the following article published by CMS on the Ambulance Services Center on the CMS website: Guidance on Beneficiary Signature Requirements for Ambulance Claims Calendar Year 2009 Update. The article can also be found at: http://www.cms.gov/AmbulanceFeeSchedule/downloads/Guidance
Provider Signature Issues: Signatures have been an issue due to the CERT contractor assigning errors on claims when reviewing claim documentation due to missing or illegible provider signatures. To learn more, go to: http://www.cms.gov/MLNMattersArticles/downloads/MM6698.pdf
Medicare HMO/Advantage Plan Issues: HMO/Advantage plans are required to offer the same basic coverage as fee-for-service Medicare. Do not submit claims for services provided to beneficiaries in Part C plans to WPS. These claims are to be submitted to the plan.
Educational Needs/Events: Discussed the recent ambulance education teleconferences, which were set up as two separate two-hour sessions. Members said they liked the new format. Another teleconference is being planned in the future. Topics that might be beneficial for ambulance providers in the future include: MSP, Comprehensive Error Rate Testing (CERT) teleconferences, basic principles of Medicare, self-service technology. Providers are encouraged to sign up for the CMS Ambulance list-serv message and the notices for the CMS Open Door Forum (ODF) calls. Learn more about educational opportunities at: http://www.wpsmedicare.com/j5macpartb/training/training_programs/
PET Minutes - Oct. 13, 2009
Minutes for Ambulance Provider Education and Training (PET) Advisory Committee for Iowa, Kansas, Missouri and Nebraska, Oct. 13, 2009
In attendance: Metropolitan Ambulance Services Trust (MAST), Midwest Billing (LifeTeam), St. Charles County Ambulance District, Siouxland Paramedics and Valley Ambulance
Provider enrollment: The Provider Enrollment (PE) unit is sending out letters to some providers regarding the need to contact the PE unit. A special email was sent to the AMB PET group as well. Providers that need help completing the application forms can contact the PE unit. Providers who receive a letter will need to comply within 60 days. If providers do not comply, they will be denied access to Medicare.
Comprehensive Error Rate Testing (CERT): The CERT program applies to all provider types including ambulance suppliers. Ambulance providers can receive a request for documentation for an ambulance service. CERT has been set up to determine if a claim has been paid correctly. Providers must respond timely to the CERT letter by sending in all required documentation. If the documentation is not submitted, is incomplete, or does not support medical necessity, the claim can be denied and an overpayment assessed to the provider of the services. CERT information is available on the WPS Medicare website at: http://www.wpsmedicare.com/j5macpartb/departments/cert/ or on the CMS website at http://www.cms.hhs.gov/cert/
Recovery Audit Contractor: The RAC contracts have been established. Contact information is available on the CMS website. Providers may receive requests for documentation from a RAC. For more information, go to: http://www.cms.hhs.gov/RAC/01_Overview.asp#TopOfPage or RAC Health Data
Insights: https://racinfo.healthdatainsights.com/
GY Modifier Usage: The GY modifier is used to indicate that a specific service is not covered by Medicare. Providers should be referring to the Ambulance Guide and the Modifiers Fact Sheet for GY modifier usage. Use of this modifier affects liability for the services. The beneficiary or patient will be held liable for the cost of the services when this modifier is used. For more information on modifier usage, go to: http://www.wpsmedicare.com/j5macpartb/training/resources/modifiers/files/gy.pdf
Ambulance Guide Book: The guide was updated and posted to the ambulance page. Ambulance providers should be referring to this guide for guidance as well as the CMS Internet Only Manuals (IOM) found on the CMS website.
Website/Ambulance Specialty Page: Members are encouraged to use this page which is set up to be a one-stop shopping guide for ambulance information.
Educational Needs: The PET Board is researching ideas for ambulance education next year. Ideas being considered include: interrupted stays and readmissions; GY modifier usage; beneficiary signature requirements; new contracts with billing companies; completion of the Physician Certification Statement (PCS) form in relation to SNF/Hospital completing it correctly; American Hospital Guide.
Membership Information: Several members submitted information which is being compiled into a chart for future WPS POE ambulance education disbursement. Ambulance partner events need to be requested by providers.
Medicare Advantage Plans – Impact on Ambulance Services: Medicare beneficiaries who are enrolled in a Part C plan, should submit their claims to that plan. Do not send these claims to WPS for processing. Problems with Part C plan patients due to problems with enrollment can only be corrected by the patient. WPS contractors cannot help with these issues.
Previous PET Minutes
Meeting minutes for WPS Medicare Part A/Part B, May 7, 2009
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