CMS Adopts Fractional Mileage
early December of 2010, CMS adopted Change Request #7065 which
discontinues the previous policy of rounding-up ambulance
mileage to the nearest mile and replaced it with a rule that
requires the calculation and reporting of mileage to the nearest
1/10th of a mile.
change went into effect on January 3, 2011 for all claims
with a date of service on or after January 1, 2011 with mileage
less than 100 miles. The notice of this change was less than
30 days from the implementation date and has raised many unanswered
technological and logistical questions.
the logistical side there are the issues of vehicles and recording
procedures that are not capable of displaying or recording
1/10th of a mile.
the technological side are the issues of billing software,
electronic claims software and carrier claim receiving software
that have was given less than 30 days to implement this change.
of January 1, 2011 Version 5.62 of The EMS Accounting System
allows the entry of mileage to the nearest 1/10th of a mile.
We also implemented measures to deal with carriers who have
not adopted the change.
carrier that wants to match Medicare’s new rule must
also publish new documentation implementing the change and
specifying the procedures for compliance. To date, virtually
all other carriers have not adopted the change.
leaves us with the situation where Medicare requires decimal
reporting but many other carriers will reject it. Of particular
concern is what to do when there is a mismatch of requirements
on the same claim.
User Update: Dealing with a Mismatch in Reporting Requirements:
To deal with a mismatch in reporting requirements, we have
implemented the following changes to The EMS Accounting System:
total mileage fee will always be calculated and displayed
as the entered mileage (decimal or not) times the fee-per-mile
is paramount to keep the accounting intact
setting is now available on a carrier-by-carrier basis that
defines how to deal with a mileage amount that has a fraction.
the fractional mileage
any fractional mileage as rounded-up to the nearest
any fractional mileage as rounded-down to the nearest
the entry of any fractional mileage on a claim that
involves this carrier
Medicare carriers will be defaulted to displaying fractional
mileage while all other carriers will be defaulted to displaying
any fractions rounded-up (you will need to hand-set any
a claim that has 8.5 miles at $10/mile would have a total
mileage charge of $85. If Medicare is the primary carrier,
their claim would display 8.5 miles totaling $85. If a secondary
form needs to be submitted to a carrier who wants mileage
rounded-up, their mileage line would read 9 miles totaling
$85. This system keeps the overall accounting straight and
satisfies both carriers’ requirements.
above, the Medicare carriers will default to using the fractional
mileage while all other carriers will be initially defaulted
to displaying any fractional mileage for their claims rounded-up
to the nearest mile while retaining the total mileage amount
calculated based on the fractional entry.
believe this system is the best alternative to deal with the
variety of situations that are likely to be encountered and
has worked well through the first quarter of 2011.
feel free to call us at (815) 578-4122 for complete details
and update instructions.