By Samantha Hilker

Patrick Ryan, co-owner of Ryan Brothers Ambulance and current PAAW board member, worked furiously to correct a problem some services may not have known they even had. 

A few weeks ago, Patrick noticed something strange.  The MTM transfers were being reimbursed at $1.75/mile instead of $5.56/mile, and even more curiously, some were being all out denied.  A deeper look revealed a potential cause of the problem: billing codes.  Typically, BLS and ALS transports are submitted to MTM with the codes A0380 and A0390, respectively, whereas the code reserved for stretcher vans is A0425 with a reimbursement rate of $1.75. 

“On some shorter trips, the difference wasn’t that much and might not be immediately obvious as it would on the long-distance transfers.  Depending on the services typical number of MTM transports and their distance, they may not have even noticed a change in their reimbursement rates for MTM trips.  It was a few long-distance trips that really raised the flag for us.”
—Patrick Ryan 

Patrick started making phone calls to other PAAW members to find out if they had noticed any of the same with their MTM authorizations and claims; sure enough, Patrick wasn’t alone.  He then reached out to MTM and DHS to find out more.  After many phone calls and email conversations, it appears the issue was one of miscommunication and misunderstanding. 

DHS has submission requirements that MTM must follow when submitting claims to DHS.  This is not to say that DHS can, in any way, enforce MTM’s provider submission expectations; so, when DHS made a request to MTM regarding code A0425, it should not have affected how ambulance service providers were being reimbursed from MTM.  As of this morning, PAAW received confirmation that MTM has revised their position on the ambulance codes and will allow providers to submit under codes A0380 and A0390 so they can be paid appropriately for the level of service provided.  MTM will also be pulling all claims that were denied for not being coded as A0425 and will be working to get them corrected and paid.  At this point, it looks as though there will not need to be any action taken on the part of the Ambulance Service Provider, however, you may want to look at your recent MTM transfers to see if you were affected. 

This is a great example of how PAAW benefits its members by building a network of professionals who are willing to step in, take the lead and find the answers; not only for their own service but to the benefit of services across the state.  Way to go, Patrick—PAAW is proud to have you!