Tag: ICD-10

Cyber Week Sale

This week only (through 12/2/16), take advantage of 25% off all AAA publications and our upcoming Webinar “I Really Can’t Stay… Managing Employee Leave” by HR Consultant, Scott Moore.

2016 Medicare Reference Manual

The American Ambulance Association’s 2016 Medicare Reference Manual is a must have for billing offices that deal with ambulance transports. Also included is the AAA’s 2015 HIPAA Guide, keep your staff up to date on patient signature requirements, levels of ambulance service, payment for ambulance services, claims processing, and much more! With margins tighter than ever, this manual will be sure to save your company money.

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Non-Member Price: $300.00
Member Price: $150.00

2015 Human Resources Handbook

The AAA Human Resources Policy & Procedure Toolkit is an essential resource for HR teams around the country. The AAA’s HR Handbook is designed to help keep ambulance services compliant with ever-increasing federal legal requirements for employers. This handbook can serve as an outline for your service to draft or update its own human resource policy manual. Don’t leave your service exposed, use the AAA’s HR handbook to keep your HR policies and procedures up to date.

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Non-Member Price: $195.00
Member Price: $97.50

Bundle: 2015 Compliance Manual and 2014 Documentation Guide

The AAA’s 2015 Compliance Manual provides a model for ambulance services to use in developing their own compliance program. This manual can also be used to provide training and educational material to your service’s compliance team. With government regulations becoming stricter, it is crucial for your service to have a solid compliance program.

The American Ambulance Association’s 2014 Documentation Guide is designed to assist ambulance service organizations and EMS training institutions in educating their emergency medical technicians, paramedics, personnel, and students in the appropriate standards for documentation. The healthcare field demands a higher and more consistent quality of documentation and this guidebook will help your service with gathering and submitting the proper information demanded by regulatory agencies, insurance payors, and consumers.

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Non-Member Price: $325.00
Member Price: $162.50

(Don’t need the full bundle? Compliance Manual and Documentation Guide are available separately for $190 (n0n-member)/$95 (member) each)

Guide to ICD-10 for Ambulance Services

Authored by experienced practitioners, the Guide to ICD-10 for Ambulance Services, is a billing department must have. The guide covers condition codes, payor specific information, ICD-9—ICD-10 crosswalk and other practical documentation and compliance information for billing and coding. This guide is an excellent tool for companies that deal with ambulance billing.

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Non-Member Price: $240.00
Member Price: $120.00

Novitas – Denials

This advisory is for members who have Novitas as their Medicare Administrative Contractor.

On August 17, 2016, Novitas called me to let me know that they are seeing many ambulance claims denied due solely to the diagnosis codes that are listed on claims. Novitas requires a minimum of two ICD-10 codes, as follows:

  • A primary diagnosis code that describes the patient’s medical condition at the time of transport, AND
  • A secondary diagnosis code that reflects the patient’s need for the ambulance at the time of transport.

The list of primary ICD-10 codes was published by Novitas in their Ambulance Local Coverage Article A54574. While the ICD-10 codes in A54574 are not the only codes that will be accepted, it is highly recommended that you use one of those as your primary code, whenever possible.

Novitas also requires a secondary “diagnosis code”. This list is in their Ambulance Local Coverage Determination (LCD) Policy L35162. That has the four “Z” codes, at least one of which must be used as the secondary diagnosis code:

  • Z74.01 – Bed Confined
  • Z74.3 – needs continuous supervision (includes EKG)
  • Z78.1 – physical restraints (patient safety, danger to self/others)
  • Z99.89 – dependence on enabling machines (includes IV fluids, active airway management)

If the claim does not list a primary AND a secondary code, the claim is automatically denied. While the claim can be corrected and resubmitted for processing, that delays cash flow and adds time and expense for the ambulance supplier. Therefore, please make sure you list an appropriate primary code AND an appropriate secondary code.

 

Member Advisory: CMS Releases the ICD-10 Crosswalk

By Kathy Lester, JD, MPH | AAA Healthcare Regulatory Consultant | October 9, 2015

At the end of last week, CMS posted the ICD-10 crosswalks for medical conditions for ambulance services. The documents can be found here, under the Other Guidance section at the bottom of the webpage.

In creating the crosswalk files, CMS relied upon a program developed by 3M, ICD-10 CTT. The files provide comprehensive crosswalks for both primary and alternative specific codes and are intended to supplement the existing Medical Conditions List.

The AAA has been working with CMS for the past year to create an official document that addresses the medical condition codes upon which some of the Medicare contractors rely for billing and auditing purposes.

While we are pleased that CMS has recognized the need for a crosswalk, we are concerned that the documents posted are a literal crosswalk of the previous ICD-9 list. This document can also be found on the Ambulance Service Center webpage. This approach, which incorporates all potential ICD-10 codes, has resulted in a large number of codes being included in the crosswalk. Some of these codes are inappropriate to use because they require diagnostic skills that extend beyond the scope of ambulance personnel.

The AAA has developed a more streamlined list of condition codes that eliminates those codes that are inappropriate for ambulance services to use.

We continue to work with CMS to refine its crosswalk to ensure that it is useful to ambulance services throughout the country.

Ambulance Open Door Forum, April 22, H.R. 2

CMS held its latest Ambulance Open Door Forum on April 22. It started with the following two announcements:

– H.R. 2 was signed into law extending the temporary ambulance adjustments through December 31, 2017. The adjustments are 2% (urban pick-ups), 3% (rural) and 22.6% (super rural).

– For free standing facilities, use the “P” modifier if the facility is not part of the hospital and use “H” if it is hospital-based.
Following these announcements, there was a Question and Answer period. Most of the questions were not answered on the call and the caller was asked to submit their questions to CMS, or was told to ask their Medicare Administrative Contractor or was told to appeal the denied claim referenced in their question. A few were answered, as follows:

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