Program_Memos / 2000 / AB-00-88

Why This Topic Matters

It matters because it establishes the administrative framework for processing ambulance claims during the fee schedule transition and identifies the reporting and system updates needed to support correct payment handling.

Article Sections

1. Summary of claims adjudication under the transition

   Summarizes the claims-processing approach used during the transition period, including locality determination, file crosswalking, and the overall structure of blended payment handling.

2. Transition for Providers (Intermediaries)

   Describes how provider claims are handled during the transition period and how calendar-year timing affects blended payment treatment.

3. Payment Requirements for Providers (Intermediaries)

   Outlines the general payment calculation framework for provider claims and the year-by-year progression through the transition period.

4. New Providers

   Addresses how the memorandum treats providers entering the system without prior-year historical payment information.

5. Calculation of Fee Schedule Payment during Transition

   Explains the operational framework for determining fee schedule payment during the transition, including geographic routing and claim reporting references.

6. Examples

   Provides illustrative payment calculation examples showing the transition-period structure applied to sample claims.

7. Billing Requirements for Providers (Intermediaries)

   Lists the claim reporting elements, form locations, and general billing requirements used for ambulance claims during the transition period.

8. Edits (Intermediaries)

   Describes automated claim edits intended to validate required ambulance claim reporting elements.

9. CWF (Intermediaries)

   Covers how procedure and payment data are represented in the CWF financial record structure.

10. Provider Statistics and Reimbursement Report (PS&R) (Intermediaries)

    Explains how ambulance-related charges are tracked separately for reporting and settlement support.

11. HCFA-SUPPLIED FILES FOR IMPLEMENTING THE AMBULANCE FEE SCHEDULE (Intermediaries and Carriers)

    Introduces the HCFA-supplied files used to support implementation and identifies the general purpose of each file.

12. Zip Code File

    Describes the structure and retrieval process for the zip code file used to map geographic information to fee schedule locality.

13. Ambulance Fee Schedule File

    Describes the national fee schedule file and its role in supporting payment amount lookup by locality.

14. Test File

    Notes the availability of a test file for implementation support and validation.

15. Final Fee Schedule

    Notes the expected availability of the final national file for operational use.

16. Miscellaneous Procedural Policies (Intermediaries and Carriers)

    Covers several additional operational topics related to ambulance claims processing during the transition period.

17. Medicare Summary Notice (MSN) and Explanation of Medicare Benefits (EOMB) and Remittance Advice (Intermediaries and Carriers)

    Addresses communication and notice content associated with claims processing outcomes.

18. Multiple Patients

    Discusses how payment is handled when more than one patient is transported together.

19. Effect of Beneficiary's Death

    Covers payment handling scenarios associated with beneficiary death in relation to ambulance transport.

20. Multiple Arrivals

    Addresses situations in which more than one unit responds to a call and how the transporting entity is handled.

21. Provider/Supplier Notification (Intermediaries and Carriers)

    Explains communication expectations for informing providers and suppliers about implementation timing and related materials.

22. Attachments

    Introduces the supporting attachments included with the memorandum.

23. ZIP CODE FILE

    Presents the record layout for the zip code file attachment.

24. Ambulance Fee Schedule

    Presents the record layout for the ambulance fee schedule attachment.

25. Attachment B

    Provides a crosswalk between new ambulance HCPCS codes and prior codes, along with service-level groupings and related definitions.

26. Definitions of Level of Service

    Defines the major ambulance service categories referenced in the crosswalk and payment guidance.