Medicare Publishes Final Rule on Fractional Mileage

On November 19, 2010, CMS released Transmittal 2103 which announces a change (outlined in the CY 2011 Physician Fee Schedule Final Rule) for ambulance provider reporting of fractional mileage amounts on ambulance claims. CMS will implement these changes to improve reporting and payment accuracy.

Effective for claims with dates of service on and after January 1, 2011, ambulance providers and suppliers must report mileage units rounded up to the nearest tenth of a mile for all claims (except hard copy billers that use the UB-04) for mileage totaling less than 100 covered miles. Providers and suppliers must submit fractional mileage using a decimal in the appropriate place (e.g., 99.9). Contractors shall truncate mileage units with fractional amounts reported to greater than one decimal place; e.g., 99.99 will become 99.9 after truncating the hundredths place.

For trips totaling 100 miles and greater, suppliers shall continue to report mileage rounded up to the nearest whole number mile (e.g., 999). Contractors shall truncate mileage units totaling 100 and greater that are reported with fractional mileage (e.g., 100.99 will become 100 after truncating the decimal places).

For mileage totaling less than 1 mile, providers and suppliers must include a “0” prior to the decimal point (e.g., 0.9). For ambulance mileage HCPCS only, Carrier/A/B MACS shall automatically default “0.1” unit when the total mileage units are missing in Item 24G of the Form CMS-1500 paper claim. FI/A/B MACs shall continue to return claims when the total mileage units are missing.

NOTE: This policy applies only to ambulances services billed on a Form CMS-1500 paper claim, ANSI X12N 837P and 837I electronic claims. This is not applicable for UB-04 paper claims. Mileage is reported in Item 24G of the Form CMS-1500 claim or the corresponding loop and segment of the ANSI X12N 837P electronic claim and the appropriate loop and segment of the ANSI X12N 837I electronic claim.

NOTE: The 4010A1 and 5010 flat files for the 837I have been updated to facilitate implementation of the requirements in this CR and are attached. Future changes to the 4010A1 and 5010 flat files will be made through the normal process. The 4010A1 and 5010 flat files for the 837P do not require revision in order to implement this CR as they are already formatted to accept fractional amounts in the units field.

Transmittal 2103 changes the following sections of the IOM:
“¢ Chapter 15 sections 30.1.2 and 30.2.1
“¢ Chapter 26 section 10.4

For the CMS Transmittal 2103, go to:
http://www.cms.gov/transmittals/downloads/R2103CP.pdf

For CMS’s MLN Matters article, go to:
http://www.cms.gov/MLNMattersArticles/downloads/MM7065.pdf

For the Federal Register Notice, go to:
http://www.pwwemslaw.com/CMS/uploads/File/11.29.10%20CY%202011%20Published%20PFS%20Rule%20-%20Ambulance.pdf

The CAA wishes to thank Kathy A. Montoya, RMC, Palmetto GBA J1
Medicare Part B, Ombudsman for CA and NV for providing this update.
 

Previous articleBound Tree Medical Launches University Website
Next articleZOLL Receives Leadership Award

No posts to display