An important ambulance billing best practice is knowing how to code ambulance transport origins and destinations properly.
This blog post is part of a series that addresses ambulance billing best practices. Our ambulance billing blog series highlights tips and insights to help you improve ambulance billing efficiency, lower ambulance claim rejections, and get reimbursed faster.
Origin and destination modifiers, along with mileage requirements set ambulance billing apart from other types of medical billing.
Ambulance billing is a specialty unto itself, with a very unique set of requirements. Origin-destination modifiers, along with mileage requirements are examples of coding elements that set ambulance billing apart from other types of medical billing.
In this post we share what we have learned over the past two decades about coding proper origins and destinations when ambulance billing.
Follow CMS Guidelines
When it comes to identifying proper origins and destinations, it is a common practice to follow the Centers for Medicare and Medicaid (CMS) guidelines for ambulance billing, given most commercial carriers have adopted these guidelines as well.
The Medicare Learning Network recently released a MLN Booklet that does a good job of explaining ambulance billing topics and guidelines.
Determine Appropriate Origin-Destination Modifiers
Modifiers that identify the place of origin and destination of the transport must be submitted on all ambulance claims. Each modifier consists of two characters, the first character represents the origin and the second character represents the destination.
For example, modifier HN should be used for an origin of hospital and a destination of nursing home. A second modifier can be added to a claim which represent additional claim requirements like GW-not hospice related or GY-not medically necessary.
CMS IOM Publication 100-04, Chapter 15, Section 30 covers the use of origin and destination modifiers.
Understanding the various combinations of origin-destination modifiers avoids rejections but also ensure the amount paid is accurate.
Using the wrong modifier could set you up for potential audit failures and lead to major refund requests. A common example of incorrect modifier use is applying a hospital modifier when it is really a physician’s office or clinic. Just because a patient is taken through the hospital emergency department, does not mean the hospital modifier should be coded as the receiving facility (destination). The patient visit could be to see a physician with an office located in the hospital.
Understand Mileage Scenarios
Various mileage scenarios such as miles beyond closest facility have different ambulance billing requirements. See CMS regulations and guidance, page 45 for some common mileage scenarios.
If you want correct payment on medically necessary transports, the transport should be to the closest appropriate facility. Unless otherwise pre-authorized by the payer, in scenarios such as patient preference, be sure the patient, or patient representative, signs an Advanced Beneficiary Notice (ABN) form.
Keep Excellent Records
Keep in mind, CMS has up to 11 years to audit EMS transports. Recently, the focus has been on non-emergent transports. Therefore, all EMS billers and transporting agencies need to assure that required forms (like ABNs) and signatures are obtained, and retained. Attaching supporting documents to the electronic patient care report or directly to the bill is recommended.
AIM Can Help You With Origin-Destination Modifiers & Mileage Challenges
AIM Online EMS Software (dispatch, ePCR, billing) and EMS Billing Services is here to help you overcome your ambulance coding and billing challenges. Call us at 1-800-726-4690, fill out our online information request form, or read more about EMS best practices.