Trailblazer Strikes Again??

[Guest guest]

Has anyone dealt with this yet?  Any comments?

 

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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]

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?

>  

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> 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

>  

>

>