The devastation in Texas and surrounding states from Hurricane Harvey is horrific. Those of us in other parts of the country ache with concern for the people impacted by this terrible storm. First responders, EMS, police, fire personnel and citizen volunteers have done an incredible job helping their communities to cope.

Among the many rescue efforts was the call to move patients in hospitals and nursing homes to safer locations. Eventually, the storm will pass and cleanup efforts will begin. Among those efforts will be the need to capture some reimbursement for the transports (so that providers can continue to operate and be there next time for their communities).

Today we bring a quick refresher on how Medicare and commercial insurers typically respond to disaster and reimbursement for services. We start first with Medicare and address commercial insurers next.

There are special modifiers Medicare requires when billing for disaster-related transports. To apply for reimbursement using the special modifiers, there had to be a declaration of emergency from the President. Please click here to read about the 1135 Waiver requirement. Medicare recently updated their questions and answers related to disaster-related transports. As always with Medicare, the coverage requirements must be met (i.e., the ambulance transport must be medically necessary).  Look here to Section F for ambulance questions about disaster transports, like the following:

“Question: Will Medicare pay for ambulance services for emergency evacuation situations?

Answer: Medicare contractors may make payment for ambulance transports for evacuating patients from locations affected by an emergency/disaster. The regulatory requirements must be met in order for such ambulance transports to be covered (i.e., the vehicle must meet certain requirements, the crew must be certified, ambulance services must be medically necessary, the transport must be from an eligible origin and to an eligible destination, certain billing and reporting requirements must be met, and Medicare Part A payment is not made directly or indirectly for the services).”

Medicare guidance is also available here to help providers and billers prepare claims that result from transports performed during a disaster.

“Question: Do the condition code “DR” (disaster related) and modifier “CR” (catastrophic/disaster related) apply to hospital-based ambulance providers?

Answer: The “DR” condition code and the “CR” modifier both apply to ambulance claims submitted by institutional providers to Medicare FIs or MACs. However, only the “CR” modifier, but not the “DR” condition code, applies to suppliers submitting claims to Medicare Carriers or MACs. Neither carriers nor the Part B side of MACs use the “DR” condition code.”

Every patient will not be a Medicare beneficiary. Providers will need to work with commercial insurers as well. When the storm necessitated movement of patients from one facility to another, that transport likely fell into the category of “non-emergency transport.” As we all know, non-emergencies usually require authorization or network participation (contracted) to assure payment for services. However, disaster may change those requirements.

On Tuesday, AISHealth reprinted a November 5, 2012 article that appeared in Health Plan Week which discussed the response of health insurers to Hurricane Sandy. To quote the article,

“Superstorm Sandy put to test contingency plans that health insurers activate for emergencies, such as easing restrictions for prescription drugs and health care services, even if out of network, at a time when large swaths of the Mid-Atlantic and Northeast regions are digging out from catastrophic damage.”

The article went on to discuss the response of various insurers during the Sandy crisis. They acknowledged that people would have been displaced from their homes without access to network providers. For example, United Healthcare “eased restrictions” for their Medicare Advantage, Medicaid and commercial products for fifteen days. Aetna eased access to some services and extended their claims filing and appeals limits. Blue Cross waived certain pre-certification, referral and admissions requirement as well as temporarily changing its payment policies for out-of-network emergency services. Cigna also temporarily waived pre-cert requirements and decided to pay out-of-network claims at in-network rates. Humana was responsive to their member needs.

It is likely that the lessons of prior disasters will influence how commercial payers react to providers’ requests after Hurricane Harvey. Remember, the local offices of payers also feel the ravages of the storm.

This is a most difficult time. It has been my privilege to work with many ambulance services in Texas, Louisiana, Alabama and Florida. I am proud and moved as I watch your efforts. I cannot do what you do. But hopefully this information will help as you go forward.

About the author:  Maggie Adams is the president of EMS Financial Services, with 25 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. Check out our newest documentation training webinars and billing webinars on our website.Friend EMS Financial on Facebook, or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com