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Revision to Certification for Hospital Services Covered by the Supplementary Medical Insurance Program as it Pertains to Ambulance Services. Change Request (CR) 5833 Rescinds and Fully Replaces CR 5684 (AMB)
Posted January 11, 2008
MLN Matters Number: MM5833
Related Change Request (CR) #: 5833
Related CR Release Date: December 21, 2007
Related CR Transmittal #: R50GI9
Effective Date: September 17, 2007
Implementation Date: January 7, 2008
The Acute Inpatient Prospective Payment System Fact Sheet (revised November 2007), which provides general information about the Acute Inpatient Prospective Payment System (IPPS) and how IPPS rates are set, is now available in downloadable format at www.cms.hhs.gov/MLNProducts/downloads/AcutePaymtSysfctsht.pdf from the Centers for Medicare & Medicaid Services Medicare Learning Network.
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, fiscal intermediaries (FIs), and/or Part A/B Medicare Administrative Contractors (A/B MACs)) for ambulance services provided to Medicare beneficiaries.
Provider Action Needed
The article is based on Change Request (CR) 5833, which updates §20 of Chapter 4 of the Medicare General Information, Eligibility, and Entitlement Manual as it pertains to Physician Certification Statement requirements for all ambulance providers. CR 5833 deletes from that manual section the paragraph that requires a physician certification of ambulance services provided by a hospital to transport a patient during an emergency situation, such as transport from the scene of an accident.
Background
The Centers for Medicare & Medicaid Services (CMS) discovered there was a problem with a paragraph in the Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4, §20 regarding language not allowing the current exception under Physician Certification Statement (PCS), i.e., that the PCS is NOT required during an emergency situation (such as the scene of an accident).
Therefore, CR 5833 deleted the following paragraph in Chapter 4 (§20) of the Medicare General Information, Eligibility, and Entitlement Manual (Pub. 100-01) that pertained to Physician Certification and Recertification of Services and Ambulance Services because it conflicted with Title 42 of the Code of Federal Regulations (CFR), §410.40(d)(2) and (3):
Certification by a physician in connection with ambulance services furnished by a participating hospital is required. In cases in which the hospital provides ambulance service to transport the patient from the scene of an accident and no physician is involved until the patient reaches the hospital, any physician in the hospital who examines the patient or has knowledge of the case may certify as to the medical need for the ambulance service.
Deletion of this paragraph brings the manual into alignment with current regulations, which eliminate the PCS requirement in these emergency situations.
Additional Information
The official instruction, CR 5833, issued to your Medicare carrier, FI, and A/B MAC regarding this change may be viewed at www.cms.hhs.gov/Transmittals/downloads/R50GI.pdf on the CMS Web site.
If you have any questions, please contact your Medicare carrier, FI, 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.
It's seasonal flu time again! If you have Medicare patients who haven't yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu and potential complications by recommending an annual influenza and a one-time pneumococcal vaccination. Medicare provides coverage for flu and pneumococcal vaccines and their administration. - And don't forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot - Not the Flu! Remember - Influenza vaccination is a covered Part B benefit but the influenza vaccine is NOT a Part D covered drug. Health care professionals and their staff can learn more about Medicare's coverage of adult immunizations and related provider education resources by reviewing Special Edition MLN Matters article SE0748 at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf 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. |
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