Ambulance Fee Schedule (AFS): Comprehending the Basics


The ambulance fee schedule has basically two components -- the base rate and then mileage. The base rate relates to whether it's BLS, BLS emergency, ALS, ALS emergency, etc— and mileage is pretty straightforward. The ambulance fee schedule payment equals a base rate payment plus a payment for mileage.

What does the fee schedule amount include? As per asc training articles, the amount that nationally uniform base rate, which is called a “conversion factor”, relative value units, and geographic adjustment factor is based upon is the GPCI (geographic practice cost index) relative to RBRVS, nationally uniform loaded mileage rate, additional amount for certain mileage for a rural point-of pickup. Air ambulance actually is a little bit easier because we have national uniform rates for fixed wing and rotary wing, and then we throw in the geographic factors and then again the uniform loaded mileage rate, plus, the rural adjustments. The geographic adjustment factors for fee schedules are very common under Medicare. Now, when it comes to mileage, the patient has to be onboard, and it’s in statute miles. In case, ambulance picks up the patient but then takes them to a doctor’s office first, and from there takes them to the hospital, Medicare will pay for the extra miles. Another important thing to remember is the zip codes in the point of pickup. This year the ambulance inflation factor is a very nice 5%.

Now, when it comes to billing and coding, the specific requirements for you to bill, code, file the claim would depend a little bit upon who you are. Now, if you're going to be an ambulance provider for the Medicare program at least you have to gain billing privileges. And that takes us off into a whole another realm which is called – CMS form 855. In this case, you'll have to fill out the form 855B which is a big long form. And there's a special ambulance section in there so that you can get your billing privileges with the Medicare program. Of course you'll have to have a nationally approved identifier. You'll get that through the PAYCO system. Let’s, presume you have billing privileges with the Medicare program. And so, you were either billing the fiscal intermediary or you're billing the carrier on the 1500 claim form. Now, what about billing requirements at least for hospitals? Well, we have to have the appropriate type of bill which is usually not a problem. From the charge master, we're going to need a revenue code which typically is 540. Technically, revenue codes are four digits. So it's 0540. Then of course, there are the base rates in the mileage HCPC codes where they’ve given some of those to you already. Modifiers, oh, yes we have to have modifiers. One of the modifiers is the point of origin or the point of destination. And the modifier as to whether it was direct provider or whether it's under arrangements. On the other hand zip code reporting is critical, service dates, service units. Now, it's interesting, in ambulance services whether it's the UB04 or the 1500 claim form, we need to put in additional information in the comments box. This is very important.

Always remember Medicare needs to be convinced about what they should pay for this service that’s being provided. And that's where the additional information on the UB04 is required. That's on locator 80, plus we need to put in some extra information. Now, for most other hospital claims, form locator 80 is not used a lot. It’s always wise to make sure that your billing system can appropriately accommodate the additional information going in there. You'll only have a limited amount of space. You have to abbreviate. You have to use acronyms but put in as much as you can that explains why, what, when, and where?

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