Question on MA Mileage
We are using the state RUCA formula for submitting MA
transportation claims (A0090) and are combining round trips into one service line.
The problem we are running into is that we are being reimbursed only .22 even
when the zip code is considered “rural”.
One suggestion we have received is to bill different service
lines for each one-way trip instead of combining into a single round trip,
using a modifier to indicate the return trip. There is no modifier listed
in the link below. In the past, trips with the same service date
would be rejected.
See the MHCP Provider Manual,
Transportation Services:
- Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information section. This has information at the end of the section on the RUCA calculation criteria.
Has anyone else experienced this issue? How did you
modify the billing process?
Diane
Aschnewitz
Fiscal Supervisor
Otter Tail County Human Services
530 W Fir Av
Fergus Falls MN 56537
218-998-8157
5 comments:
We are billing two lines for each trip when the RUCA applies, you then use the "76" modifier and it will pay the return trip at the RUCA rate as well as the trip there.
Penny Grove - Red Lake and Norman Counties
We used a guideline that we received from another county...
Any trips 50 miles or less, round trip...
0-17 miles are 27.5
18-50 miles are 24.74
over 50 are 22
If you are combining dates or multiple trips/day, then yes, separate lines.
At Nicollet when RUCA applies we do 1 line per one way trip unless the round trip is under 17 miles, then we will just do one line. We use the modifier "76" too. If RUCA does not apply we will just do round trip on one line.
Also they use the clients current address and one previous address in MMIS to determine if it is RUCA. Sometimes we have a situation where the clients address is not current in MMIS.
We create two lines with one having the 76 modifier. We get the full reimbursement, RUCA included.
Angie Lawson- MNPrairie
Hello Diane,
As we discussed on the phone the reason the RUCA isn’t paying is because the round trip is greater than 51 miles. In order to get paid RUCA you will need to split the trip and bill each line separately. Although the 76 modifier I gave you for same day same service will work the better way to do it is to use origination/destination modifiers as show below:
NOTE: the screen shot is not showing. It showed 2 lines for A0090 on the same date. 1 line had a RP Mod and the other line had an PR Mod
Origination/Destination Modifiers
D = Diagnostic or therapeutic site other than P or H when these are used as origin codes
E = Residential, domiciliary, custodial facility (other than 1819 facility)
G = Hospital based ESRD facility
H = Hospital
I = Site of transfer (for example, airport or helicopter pad) between modes of ambulance transport
J = Freestanding ESRD facility
N = Skilled nursing facility
P = Physician’s office
R = Residence
S = Scene of accident or acute event
X = Intermediate stop at physician’s office on way to hospital (destination code only)
Transport Mileage RUCA Adjustments
The mileage rate for nonemergency medical transportation services in areas defined under RUCA to be rural or super-rural areas is as follows:
• • For a trip 17 miles or less, the mileage rate is equal to 125 percent of the respective mileage rates for modes 1 through 7
• • For a trip between 18 and 50 miles, the mileage rate is equal to 112.5 percent of the respective mileage rate for modes 1 through 7.
• • For a trip billed with 51 or more miles on the claim service line, the RUCA add-on adjustment calculations would not apply.
I hope this helps.
Please feel free to contact me with any further questions.
Thank you.
April Beachem
MHCP Provider Trainer | Member & Provider Services
Minnesota Department of Human Services
540 Cedar St.
St. Paul, MN, 55101
O: 651-478-8565
F: 651-431-7439
mn.gov/dhs
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