Provider Types Affected
Ambulance suppliers who submit claims to Medicare carriers or Part A/B Medicare Administrative Contractors (A/B MACs) for ambulance services furnished to Medicare beneficiaries

Impact to You
Effective for claims processed January 1, 2008 and later, a claim for an ambulance service furnished by a supplier must be filed with the carrier or A/B MAC having jurisdiction for the “point of pickup” (POP).

What You Need to Know
Effective April 1, 2007, each carrier will begin processing applications from ambulance suppliers that are rendering services in their jurisdiction. For claims with dates of service January 1, 2008 and later, carriers will return claims as unprocessable any claim for a ground or air ambulance service where the POP is not within its jurisdiction.

What You Need to Do
Be sure your staff knows to file Medicare claims with the carrier or A/B MAC having jurisdiction for the POP to assure prompt and accurate payment.

The Medicare claims filing jurisdiction rule for ambulance services has been that an ambulance must file the claim with the carrier or A/B MAC having jurisdiction for where the service was furnished. When the ambulance fee schedule policies and systems changes were being developed, most carriers interpreted this rule to mean that a claim for an ambulance service must be filed with the carrier or A/B MAC having jurisdiction for the area where the vehicle is garaged or hangered. When the ambulance fee schedule was implemented beginning January 1, 2000, CMS determined that this de facto interpretation of the claims filing jurisdiction rule would not be changed during the fee schedule transition period which was completed on January 1, 2006. (See Program Memorandum (PM) AB-00-88, Change Request (CR) 1281, dated September 18, 2000 which was reissued as PM AB-01-185 dated December 14, 2001. CR1281 can be found at http://www.cms.hhs.gov/Transmittals/Downloads/AB01185.pdf on the CMS Web site.)

Currently all ambulance services are paid under the fee schedule which is based on the location from which the beneficiary is transported, i.e., the “point of pickup” (POP). Because the basis for payment under the fee schedule is based on the POP, it is reasonable for the claims filing jurisdiction rule to also be based on the POP.

Changing the claims filing jurisdiction to the POP will ensure jurisdictional congruence between the policies for payment and claims filing. It will additionally ensure that the ambulance supplier meets the state and local requirements where the service was furnished, which was the original intent of the claim filing jurisdiction rule. This change will:

• Bring administrative practice into congruence with the longstanding regulatory standards at 42 C.F.R. §410.41;
• Avoid having federal administrative practice undercut appropriate state and local regulatory standards; and
• Promote an appropriate level of service for all Medicare beneficiaries.

For dates of service of January 1, 2008, or later, ground and air ambulance supplier claims for a point of pick-up not rendered in the carrier’s (or A/B MAC’s) jurisdiction will be returned to the supplier as “unprocessable,” accompanied by the following remittance advice message:

• N104 - This claim/service is not payable under our claims jurisdiction area. You can identify the Medicare contractor to process this claim/service through the CMS Web site at http://www.cms.hhs.gov/  .

Carriers and A/B MACs will not apply this rule to:

• Ambulance claims submitted to the carrier that processes Indian Health Service ambulance claims, or
• Any future ambulance demonstration claims unless CMS so directs that this policy applies.

As a consequence of changing the claims filing rule to the POP, ambulance suppliers (including those who operate in multiple states) must be enrolled with the carrier in each jurisdiction where they furnish services to Medicare beneficiaries. This is the case even if that supplier does not garage or hanger its vehicles in each state in which the supplier operates (Required by 42 C.F.R. § 410.41 located at http://www.cms.hhs.gov/AmbulanceFeeSchedule/downloads/cfr410_41.pdf on the Centers for Medicare & Medicaid Services (CMS) Web site).

Note: As early as April 1, 2007, each carrier or A/B will begin processing applications from ambulance suppliers that are rendering services in their jurisdiction.

Exception: Where the POP is outside the United States, the claim for an ambulance service furnished by a supplier must be filed in accordance with the instructions in Publication 100-4, The Medicare Claims Processing Manual, Chapter 1 § 10.1.4.1. Carrier jurisdiction is defined in Publication 100-04, Chapter 1 § 10.1.4.2. These instructions can be found at http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf on the CMS Web site.

Additional Information
CR5203 is the official instruction issued to your Medicare carrier or A/B MAC regarding changes mentioned in this article. CR 5203 may be found at http://www.cms.hhs.gov/Transmittals/downloads/R1100CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare 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: MM5203
Pub. 100-4, Transmittal# R1100CP, CR# 5203
Related CR Release Date: November 3, 2006
Effective Date: January 1, 2008
Implementation Date: January 1, 2008

Flu Shot Reminder
Flu season is here! Medicare patients give many reasons for not getting their flu shot, including -- “It causes the flu; I don’t need it; it has side effects; it’s not effective; I didn’t think about it; I don’t like needles!” The fact is that out of the average 36,000 people in the U.S. who die each year from influenza and complications of the virus, greater than 90 percent of deaths occur in persons 65 years of age and older. You can help your Medicare patients overcome these odds and their personal barriers through patient education. Talk to your Medicare patients about the importance of getting their annual flu shot -- and do not forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot. Remember, influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf.

Posted: 11/10/2006

CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.