National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Revision to Certification for Hospital Services Covered by the Supplementary Medical Insurance Program as it pertains to Ambulance Services

Provider Types Affected
Physicians and hospitals who bill Medicare Fiscal Intermediaries (FI), Carriers, and A/B Medicare Administrative Contractors (MAC) for ambulance services for Medicare patients

Background
CR5684 furnishes the revised Certification for Hospital Services by the Supplementary Medical Insurance Program as those requirements pertain to physician certification of ambulance services in Chapter 4, Section 20 of the Medicare General Information, Eligibility, and Entitlement Manual.

Key Points of CR5684

• Prior to the effective date (September 17, 2007) of CR5684, certification by a physician in connection with ambulance services furnished by a participating hospital was required.
• As of the effective date of CR5684, language requiring physician certification for ambulance services furnished by a participating hospital is deleted from the above mentioned Medicare manual.
• Your Medicare FI, Carrier, or A/B MAC has been instructed to comply with this revision.

Additional Information
To view the official instruction (CR5684) issued to your Medicare FI, Carrier, or A/B MAC, visit http://www.cms.hhs.gov/Transmittals/downloads/R47GI.pdf on the CMS Web site. The revised manual section is attached to CR5684.

If you have questions, please contact your Medicare FI, Carrier, or A/B MAC at their toll-free number which may be found at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM5684
Related Change Request (CR) #: 5684
Related CR Release Date: August 17, 2007
Effective Date: September 17, 2007
Related CR Transmittal #: R47GI
Implementation Date: September 17, 2007

News Flash - Rejected Claims Reminder
Fee-for-Service Medicare claims can be rejected by Medicare contractors (carriers, intermediaries (FI), and Medicare Administrative Contractors (MAC)) for a variety of reasons including: incorrect billing information, terminated provider, the beneficiary is not eligible for Medicare or the claim was sent to the wrong contractor. If a provider has questions about a claim rejected by an FI/carrier or MAC, the provider should contact the contractor directly. It is never appropriate to direct the beneficiary who received the service billed on the claim to the 1-800-Medicare toll free line to resolve a claim rejection.