Table of Contents

CMS Announces Details of Next Ambulance Open Door Forum

Carrier Jurisdiction for Point of Pick Up
by David M. Werfel Esq.

ICD-9 Code Changes for 2007
by David M. Werfel Esq.

Contact Your Members Of Congress on Temporary Medicare Ambulance Relief

Submit Your Ambulance Cost Survey Today

CMS Announces Details of Next Ambulance Open Door Forum

The Centers for Medicare and Medicaid Services ( CMS ) announced that the next Ambulance Open Door Forum will be held on Tuesday, December 19 at 2:00 p.m. (eastern). To participate in the Forum, dial 1-800-837-1935 and provide the operator with the conference ID number of 7362106 and your name, organization name and the state from which you are calling. Below are more details on the Forum.

CMS Ambulance Open Door Forum

Date: Tuesday, December 19, 2006

Time: 2:00 to 3:00 p.m. (eastern)

Conference Call Number: 1-800-837-1935

Conference ID: of 7362106

Conference Leaders: Dr. Bill Rogers/Dr. Charlotte Yeh/Natalie Highsmith

TTY Communications Relay Services are available for the hearing impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html . A relay communications assistant will help.

ENCORE: Call Number 1-800-642-1687; Conference ID Number of 7362106.

"Encore" is a recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conference ID number of 7362106. You can access the recording of the call from Tuesday, December 19 after 5:00 p.m. (eastern) through Friday, December 22.

Carrier Jurisdiction for Point of Pick Up

By David M. Werfel, Esq.

On November 3, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 1100 (Change Request 5203). The Transmittal amends Pub. 100-04, Chapter 15, Section 20.1.2 concerning Carrier Jurisdiction. The issue was also published in a MLN Matters article by CMS, MLN Matters Number MM5203.

Effective January 1, 2008, claims for ambulance services will have to be submitted to the Carrier that serves the point of pick up of Medicare beneficiaries.

Currently, jurisdiction is based on where vehicles are garaged (ground ambulance) or hangered (air ambulance). Thus, this can be a major change for ambulance suppliers that pick up patients in more than one state.

This change will require ambulance suppliers servicing multiple jurisdictions to complete a separate enrollment application for each jurisdiction.

The AAA is currently discussing this issue and seeking clarifications on a number of points concerning this Transmittal. You can prepare and submit a new application now, if you are affected, or wait two or three months for CMS to provide those clarifications. My recommendation is that you wait as we will be asking CMS for an expedited application or one that covers multiple jurisdictions.

ICD-9 Code Changes for 2007

By David M. Werfel, Esq.

There have been changes in the ICD-9 codes for 2007 that may be of interest to you. They are as follows:

• 780.96 (Generalized pain). This is more specific than 780.99 (Pain).
• A fifth digit was added for choking. The code is now 784.99, rather than 784.9.

•  780.97 (altered mental status)

•  change in mental status

•  excluding altered level of consciousness (780.01 -780.09) and altered mental status due to known condition

• 331.83 (mild cognitive impairment).
• new category for pain, not elsewhere classified (338), including:

•  338.11 - acute pain due to trauma

•  338.18 - acute postoperative pain NOS

•  338.19 - other acute pain

•  338.21 - chronic pain due to trauma

•  338.28 - other chronic postoperative pain

•  338.29 - other chronic pain

•  344.9 (Epilepsy, unspecified) now includes recurrent seizures NOS and seizure disorder NOS

While the first three noted above could be used as condition codes, technically, CMS will have to add these changes to their existing Condition Code list. However, you can use these codes, as ICD-9 or condition codes, as they are more specific than the previous codes.

Contact Your Members of Congress on Temporary Medicare Ambulance Relief

Congress returns to Washington , DC next week to address unfinished business including possibly a fix to the physician fee schedule and Medicare provider relief. Please take advantage of this opportunity to meet with or write to, if you have not already done so, your Members of Congress on the temporary Medicare increase of 5% for 2007 and 2008 for all ambulance service providers. It is critical that Members of Congress hear from their ambulance service providers on this matter.

To write a letter using the AAA online letter writing tool, please go to: http://capwiz.com/the-aaa/home/ . You can also access the system through the AAA homepage at http://www.the-aaa.org/ and clicking on "Write Your Members of Congress". The system will fax the letters to your Members of Congress for you! It should only take a few minutes to complete.

Over 1,500 letters have been sent from ambulance service professionals to Members of Congress. However, if we are to raise the profile of this issue, we need every AAA member contact to send letters. Please also forward this e-mail your staff and ask that they also write letters. The more letters the better!

Submit Your Ambulance Cost Survey Today

All AAA members are strongly encouraged to submit and complete an ambulance cost survey. The study is essential so that the Association will have data to compare to the results of the ambulance cost study being conducted by the Government Accountability Office (GAO). The GAO is expected to release the results of their study early next year. Please submit your survey by December 5.

The AAA contracted with Quantria Strategies, LLC to conduct the survey and only their representatives, John O'Hare and Judy Xanthopoulos, and our data analyst, Chris Hogan, will see the individual data. Participation is voluntary, of course, but responses from operations such as yours are critical if the survey is to accurately reflect the experiences across the range and diversity of all providers. Please therefore take the time to complete and submit a survey.

Any and all responses you provide to assist in this effort will be CONFIDENTIAL and not shared with the AAA leadership or staff, any private organization or government entity. Our data analyst will only report information in the aggregate.

To complete this survey, please follow these instructions:

•  Access the Internet website for the survey at www.ambulancecoststudy.com and click on "Survey" on the left hand side of the homepage;

•  You will be directed to the survey log-in and asked to provide a username and password. The login information is provided below;

Username: AAAMEMBER

Password: 10001

•  Download the survey, which is an Excel spreadsheet, on to your computer;

•  Compete the survey to the best of your ability; and,

•  Once it is completed; e-mail the survey to info@ambulancecoststudy.com no later than December 5, 2006.

For those AAA members who received a letter, e-mail or phone notification about being part of the random sample and have yet to submit a survey, please use the username and password contained in the e-mail or letter to access the survey.

We hope you will take the time to participate in this important project. With your help, we will be able to provide the Congress with information necessary to ensure that your organization is fairly and adequately compensated for providing critical, life-saving ambulance services to Medicare patients. If you have any questions, please e-mail John O'Hare or Judy Xanthopoulos at: info@ambulancecoststudy.com .

Thank you in advance for your participation.

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