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Back  RFI # 1858: EMS Billing Requirement

Formal vs. Informal Help Informal Formal

Submitter

Januarie Diehl

Description

There are discrepancies in how ambulance claims are accepted by payers due to the rule below. There is no specification as to whether there should or should not be fractional mileage reported on the claim. CMS is requiring this while commercial payers are requiring that the decimal/fractional mileage be rounded. The concerns are:

1. When a provider has to alter their specific data that has been entered into their practice management system, will this not be an issue in the case of an audit that the data is not the same?
2. Are these claims being erroneously denied seeing as there is no specification as to whether a provider should be billing a certain way (example: 22 versus 21.8)

The 837P TR3 005010X222 says:
2300 CR1

REQUIRED CR106 380 Quantity X 1 R 1/15
Numeric value of quantity
SYNTAX: P0506
SEMANTIC: CR106 is the distance traveled during transport.
IMPLEMENTATION NAME: Transport Distance
619 0 (zero) is a valid value when ambulance services do not include a charge for mileage.

Submitter Assigned Keywords

EMS ambulance transport distance cr106

Response

The 005010X222 (837P) loop ID 2300 data element CR106 places no precision constraints beyond the data type R and data size 1/15 for mileage being sent in a claim. ASC X12 data type R, as specified in 837P § B.1.1.3.1.2 Decimal, permits use of values with tenths, hundredths, etc. Thus, any precision in any sent mileage value is compliant with the TR3.

Once received, the receiver may process such mileage data based on its particular business rules. This is similar in concept to the principle expressed in 837P § 1.12.2.
Submission 9/20/2013
Status Date 10/25/2013
Status F - Final
Primary References
Document 005010X222
Section1.1
Page211
Loop2300