Help! Billing for travel expenses?

eventidesky

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Hello!

I work at Lab and we send our Phlebotomists to Assisted Living & Nursing homes a few times a week. We are looking into billing to Medicare for the trip the Phlebotomist has to take to the patients and back to the lab. Has anyone billed the HCPCS code P9603 before to Medicare? is this the correct code? Are there any modifiers, etc.? Any help would be greatly appreciated. Thanks
 
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Travel Charges for Outreach Specimens

Hi-

I am a Pre-Bill Data Integrity Specialist-Lab focused. The billing for travel charges was implemented here at our facility a very long time ago- the basics are listed below and there is also information from MLN Matters- you can also look at CMS website for information.

Medicare will reimburse for travel charges for patients who are homebound or nursing home patients.
In order to capture revenue for HCPCs code P9604 documentation must be provided for the patients who meet the criteria for the charges and are within 20 miles or less round trip.
Documentation will include:
? Date of Service
? Patient Name
? Patient Location
? Patient Insurance
? Vehicle Used
? Beginning/Ending mileage
? Technician

The calculation for charges will be based on the Medicare flat rate travel allowance of $10.15. This flat rate will be pro-rated for multiple patients visited on the same trip and/or nursing home patients.

Example:
6-total patients
5-patients are Medicare recipients and meet medical necessity for homebound patients.
Trip= Leaving and returning.
Calculation = 2 x $10.15 = $20.30
$20.30 / 6 = $3.38
Charge will be $3.38 for each Medicare patient.

Travel codes allow for payment either on a per mileage basis (P9603) or on a flat rate per trip basis
(P9604). Payment of the travel allowance is made only if a specimen collection fee is also payable. The
travel allowance is intended to cover the estimated travel costs of collecting a specimen including the
laboratory technician?s salary and travel expenses. Medicare contractor discretion allows Medicare
contractors to choose either a mileage basis or a flat rate, and how to set each type of allowance.
Because of audit evidence that some laboratories abused the per mileage fee basis by claiming travel
mileage in excess of the minimum distance necessary for a laboratory technician to travel for specimen
collection, many Medicare contractors established local policy to pay on a flat rate basis only.
Under either method, when one trip is made for multiple specimen collections (e.g., at a nursing home),
the travel payment component is prorated based on the number of specimens collected on that trip, for
both Medicare and non-Medicare patients, either at the time the claim is submitted by the laboratory or
when the flat rate is set by the contractor.
Medicare Part B, allows payment for a specimen collection fee and travel allowance, when medically
necessary, for a laboratory technician to draw a specimen from either a nursing home patient or
homebound patient under Section 1833(h)(3) of the Act. Payment for these services is made based on
the clinical laboratory fee schedule.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8203.pdf

MLN Matters is a great resource for information.
 
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Phlebotomy company-travel allowance?

Hello- I work for a phlebotomy company that draws and collects specimens at nursing homes. We are not the lab company. Currently we bill the lab company directly at the Medicare travel/collection rate and I believe they bill it as a "contracted service" to Medicare. We are looking at doing our own traveling billing. Any advise on how to set this up? I haven't done Medicare billing in a couple of years and I can't recall if there is a way to bill Medicare directly without a "billing system", application help, etc? Any help would be greatly appreciated!
 
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