Trailblazer Strikes Again??

[Guest guest]

Has anyone dealt with this yet?  Any comments?

 

= = = = = = = = = =

 

Automated Denials for Non-Emergency Ambulance Transports in Texas

Date:  (6/22/2011)

Notice ID:  14409

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Automated Denials for Non-Emergency Ambulance Transports in Texas

Date:  (6/22/2011)

Notice ID:  14409

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Automated Denials for Non-Emergency Ambulance Transports in Texas

Date:  (6/22/2011)

Notice ID:  14409

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Automated Denials for Non-Emergency Ambulance Transports in Texas

Date:  (6/22/2011)

Notice ID:  14409

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Automated Denials for Non-Emergency Ambulance Transports in Texas

Date:  (6/22/2011)

Notice ID:  14409

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Automated Denials for Non-Emergency Ambulance Transports in Texas

 

Date:  (6/22/2011)

Notice ID:  14409

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Date:  (6/22/2011)

Notice ID:  14409

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Date:  (6/22/2011)

Notice ID:  14409

 

Through statistical analysis, TrailBlazer identified a potential overutilization

of HCPCS code A0428 (non-emergency ambulance transport services), billed with

modifiers RJ and JR, and its associated services (e.g., A0425) across the

provider community in Texas. Multiple postpayment probe reviews and prepayment

audits have been conducted and validated that significant overutilization

exists.

Based on the results of these reviews, TrailBlazer will implement an automated

ambulance audit for A0428 services in Texas billed with modifiers RJ and JR and

will cover no more than 12 ambulance trips per beneficiary per year. This audit

will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines†section in

the Ambulance Local Coverage Determination (LCD) posted on our Web site.

 

 

http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14409

 

[Guest guest]

First of all, it's a TrailBlazer policy and not a rule. It directly affects

the transportation of dialysis patients who reside at home. And, it's a done

deal. The reality is that the entire ambulance service industry is going to

pay the price (in terms of delayed payments) for those services that

are fraudulently billing M/C & M/A for the transport of patients who do not

meet the medical necessity criteria. I believe that these types of

restrictive payment policies, audits and criminal prosecutions will only

intensify until such time as we can muster the collective will to drive out

the bad actors, who are scamming federal and state health care reimbursement

programs out of billions of dollars each year.

If you think TrailBlazer's new policy is restrictive, check out S.1251

(Medicare and Medicaid FAST Act) that was recently introduced in the U.S.

Senate. It calls for the abandonment of CMS' current policy of " pay and

chase " (meaning pay the claim first, then go after the providers for

overpayment recovery) in favor of putting all claims for reimbursement by

qualified service providers under prepayment review. The bottom line is that

lawmakers understand that CMS is losing an estimated $100 Billion per year

to fraud, and they are going to find ways to turn off the spigot, recover

the money and imprison as many of the fraud perpetrators as possible.

Bob

On Mon, Jul 11, 2011 at 3:12 AM, blackbeard47 blackbeard47@...>wrote:

> **

>

>

> I have read this new rule over and over and it seems to me that this will

> affect patient care as well as legitimate companies. I see this as a BIG

> problem. While I agree that there are a lot of companies that are taking

> advantage of the system and should be dealt with, I don't think this is the

> way. This is going to force legitimate companies to close their doors

> because every run after 12 has to be appealed and that could take months

> even years. We all know that medicare is SLOW at paying legitimate claims

> the first time. Is it any wonder why so many places now are not willing to

> accept medicare patients. Also it does not seem that Medicare has thought

> about the patients. What happens to the patients that truly NEED ambulance

> transportation, they are going to suffer because their provider can't

> continue to operate for lack of funds.

>

> Is anyone challenging this ruling?? Is there a way to challenge this

> ruling?

>

>

> >

> > Has anyone dealt with this yet? Any comments?

> > Â

> > = = = = = = = = = =

> > Â

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> > Â

> >

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> > Â

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> > Â

> > Â

> > http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14409

> > Â

> >

> >

[Guest guest]

First of all, it's a TrailBlazer policy and not a rule. It directly affects

the transportation of dialysis patients who reside at home. And, it's a done

deal. The reality is that the entire ambulance service industry is going to

pay the price (in terms of delayed payments) for those services that

are fraudulently billing M/C & M/A for the transport of patients who do not

meet the medical necessity criteria. I believe that these types of

restrictive payment policies, audits and criminal prosecutions will only

intensify until such time as we can muster the collective will to drive out

the bad actors, who are scamming federal and state health care reimbursement

programs out of billions of dollars each year.

If you think TrailBlazer's new policy is restrictive, check out S.1251

(Medicare and Medicaid FAST Act) that was recently introduced in the U.S.

Senate. It calls for the abandonment of CMS' current policy of " pay and

chase " (meaning pay the claim first, then go after the providers for

overpayment recovery) in favor of putting all claims for reimbursement by

qualified service providers under prepayment review. The bottom line is that

lawmakers understand that CMS is losing an estimated $100 Billion per year

to fraud, and they are going to find ways to turn off the spigot, recover

the money and imprison as many of the fraud perpetrators as possible.

Bob

On Mon, Jul 11, 2011 at 3:12 AM, blackbeard47 blackbeard47@...>wrote:

> **

>

>

> I have read this new rule over and over and it seems to me that this will

> affect patient care as well as legitimate companies. I see this as a BIG

> problem. While I agree that there are a lot of companies that are taking

> advantage of the system and should be dealt with, I don't think this is the

> way. This is going to force legitimate companies to close their doors

> because every run after 12 has to be appealed and that could take months

> even years. We all know that medicare is SLOW at paying legitimate claims

> the first time. Is it any wonder why so many places now are not willing to

> accept medicare patients. Also it does not seem that Medicare has thought

> about the patients. What happens to the patients that truly NEED ambulance

> transportation, they are going to suffer because their provider can't

> continue to operate for lack of funds.

>

> Is anyone challenging this ruling?? Is there a way to challenge this

> ruling?

>

>

> >

> > Has anyone dealt with this yet? Any comments?

> > Â

> > = = = = = = = = = =

> > Â

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> >

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> > Automated Denials for Non-Emergency Ambulance Transports in Texas

> > Â

> >

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> >

> >

> >

> >

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> >

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> > Date:Â Â (6/22/2011)

> > Notice ID:Â Â 14409

> > Â

> >

> > Through statistical analysis, TrailBlazer identified a potential

> overutilization of HCPCS code A0428 (non-emergency ambulance transport

> services), billed with modifiers RJ and JR, and its associated services

> (e.g., A0425) across the provider community in Texas. Multiple postpayment

> probe reviews and prepayment audits have been conducted and validated that

> significant overutilization exists.

> > Based on the results of these reviews, TrailBlazer will implement an

> automated ambulance audit for A0428 services in Texas billed with modifiers

> RJ and JR and will cover no more than 12 ambulance trips per beneficiary per

> year. This audit will be effective on or about July 1, 2011.

> > For additional information, refer to the “Utilization Guidelinesâ€

> section in the Ambulance Local Coverage Determination (LCD) posted on our

> Web site.

> > Â

> > Â

> > http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14409

> > Â

> >

> >