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Ambulance Upcoding

Ambulance Upcoding. Chief Business Office Purchased Care Department of Program Integrity (DPI). July 2013. Objectives. Identify Ambulance Upcoding Describe BLS and ALS Procedures Determine Appropriate Charges. Ambulance Upcoding.

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Ambulance Upcoding

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  1. Ambulance Upcoding Chief Business Office Purchased Care Department of Program Integrity (DPI) July 2013

  2. Objectives • Identify Ambulance Upcoding • Describe BLS and ALS Procedures • Determine Appropriate Charges

  3. Ambulance Upcoding Billing for Advanced Life Support Services (ALS) when Basic Life Support Services (BLS) was provided

  4. BLS and ALS Procedures • BLS • Basic CPR with Automatic Defibrillator • Basic Trauma Care • Basic Airway Management • ALS • I.V. • Cardiac Monitor • Tracheostomy • Limb realignment

  5. Determine Appropriate Charges • Mode of Transportation • Mileage Rate • Level of Service • Basic Level of Service (BLS) • Advanced Level of Service (ALS) • Specialty Care Transport (SCT)

  6. Conclusion • Identify Ambulance Upcoding • Describe BLS and ALS Procedures • Determine Appropriate Charges

  7. References Veterans Affairs manages several health care programs that reimburse private health care providers for caring for our Veterans and their eligible family members. Unfortunately these health care programs have a different statutory and regulatory authority, which creates diverse payment methodologies. The majority of VA health care programs utilize Medicare’s payment methodologies or something very similar. Therefore, providers and facilities that utilize Medicare’s billing and coding guidelines will greatly minimize claim delays or rejections as a result of the Program Integrity Tools fraud and abuse review. The following Medicare link is an excellent source of billing and coding guidance for all providers and facilities: Medicare Claim Processing Guide http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf

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