Alert!!! CMS Adopts Fractional Mileage

In 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.

This 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.

On 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.

On 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.

As 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.

Every 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.

This 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.

Current 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:

• The total mileage fee will always be calculated and displayed as the entered mileage (decimal or not) times the fee-per-mile rate.
  • This is paramount to keep the accounting intact
• A setting is now available on a carrier-by-carrier basis that defines how to deal with a mileage amount that has a fraction.
  • Display the fractional mileage
  • Display any fractional mileage as rounded-up to the nearest mile
  • Display any fractional mileage as rounded-down to the nearest mile
  • Block the entry of any fractional mileage on a claim that involves this carrier
• All 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 other situations)

For example, 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.

As noted 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.

We 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.

Please feel free to call us at (815) 578-4122 for complete details and update instructions.