Starting January 1, 2012, Medicare contractors will have to accept and process claims for services such as wheelchair van transports, treatment without transport, and other ambulance services that are not covered by Medicare. Please note that this does not require Medicare to pay for these non-covered services, it merely requires that they process claims with non-covered service codes to facilitate coordination of benefits or payments by secondary insurers. Ambulance providers will have to submit these claims with a "GY" modifier to tell their contractor to deny them.
CMS recently issued Change Request 7489 to all Medicare contractors, instructing them to revise their processing systems to allow for the adjudication of claims with HCPCS codes for non-covered services. Codes for non-covered ambulance services include HCPCS codes A0021 through A0424 and A0998. This important change should enable providers to submit a code that accurately identifies the non-covered service that was furnished to the beneficiary. It will also allow ambulance providers to obtain a denial for coordination of benefits purposes. For some providers, this change should make the process for submitting claims to secondary payors much simpler because contractors will now adjudicate (deny) non-covered claims and then electronically submit the claims to the secondary payor.
To learn more, check out MLN Matters 7489. This, and other significant coding changes, like ICD-10 codes and HIPAA 5010 standards, will be discussed at PWW's all new abc3 conference in Hershey, October 26-27, 2011. Click HERE for more information on the upcoming abc3 conference.