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New Remark Code for Denying Separately Billed Services (AMB) - Revised 9-19-07
Posted September 19, 2007
MLN Matters Number: MM5659
Related Change Request (CR) #: 5659
Related CR Release Date: August 17, 2007
Related CR Transmittal #: R1333CP
Effective Date: October 1, 2007
Implementation Date: October 1, 2007
Note: This article was revised on September 10, 2007, to reflect that Change Request (CR) 5659 was revised. The CR transmittal number and the Web address for accessing CR 5659 were revised. All other information remains the same.
New Medicare Learning Network (MLN) Catalog Available
The August 2007 edition of the MLN Products Catalog is now available - the MLN Products Catalog is an interactive, downloadable document that lists all Medicare Learning Network (MLN) products by media format. The catalog has been revised to provide new customer-friendly links that are embedded within the document. All product titles and the word "download" when selected, will link you to the online version of the product. The word "hard copy" when selected, will automatically link you to the MLN Product Ordering page. To access the catalog, visit www.cms.hhs.gov/MLNGENINFO on the Centers for Medicare & Medicaid Services (CMS) Web site.
Provider Types Affected
Medicare providers who submit claims to Medicare Part A/B Medicare Administrative Contractors (A/B MACs) or carriers for ambulance services rendered to Medicare beneficiaries.
Provider Action Needed
Be aware that contractors will use a new Remittance Advice Remark Code (RARC) message when denying ambulance claims submitted with a code(s) that is not separately billable and already included in the base rate. For claims submitted by ambulance suppliers that Medicare processes on or after October 1, 2007, and which Medicare denies because the code for the service does not appear on the Ambulance Fee Schedule, Medicare will return the RARC of N390 to show, "This service cannot be billed separately." See the remainder of this article for further details.
Key Points of Change Request (CR) 5659
- Effective October 1, 2007, the new RARC N390 and N185 with Claim Adjustment Reason Code 97, group code CO, will be used when denying any codes on the ambulance claims that does not appear on the Ambulance Fee Schedule.
- For such claims processed and denied on or after October 1, 2007, the following Medicare Summary Notice (MSN) message will be sent to Medicare beneficiaries: "16.45 – You cannot be billed separately for this item or service. You do not have to pay this amount."
Background
CR 5659 is the official document that announces these changes in Medicare processes and states that effective January 1, 2006, items and services which include but are not limited to oxygen, drugs, extra attendants, supplies, EKG, and night differential are no longer paid separately for ambulance services. This occurred when the Centers for Medicare & Medicaid Services (CMS) fully implemented the Ambulance Fee Schedule. Therefore, payment is based solely on the Ambulance Fee Schedule amount as cited in 42 Code of Federal Regulations (CFR) §414.615(e) and such payment represents payment in full for all services, supplies, and other costs for an ambulance service furnished to a Medicare beneficiary. CMS was made aware that some providers are submitting claims with ancillary services that are included in the base rate.
CMS decided that a clearer denial message was needed to explain the reason for the denial and that this service is not separately billable and as a result, these claims/services should not be resubmitted. This is true whether the primary transportation service is allowed or denied. Remember that when these services are denied, the services are not separately billable to the beneficiaries.
Additional Information
For complete details regarding this CR, please see the official instruction (CR 5659) issued to your Medicare carrier or A/B MAC. That instruction may be viewed by going to www.cms.hhs.gov/Transmittals/downloads/R1333CP.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 www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site. For the Upstate Medicare Division (UMD), you can call the toll-free provider line at 877-567-7173.
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. |
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