Trailblazer Will Start Auditing More Dialysis Transports July 1!

I received the following email from Trailblazer yesterday.  Expect ALL dialysis transports to be denied initially and require submission of additional documentation and eventually require at least appeals through redetermination.  This will be just like the current situation with the RJ/JR modifier (the home to dialysis and dialysis to home trips), except that now the target is SNF and nursing home patients.  This is only going to get worse until it gets better:

TrailBlazer Will Implement a Service-Specific Audit for Ambulance Services in Texas – TrailBlazer identified a potential overutilization of HCPCS code A0428 (non-emergency ambulance transport services) billed with modifiers JN, NJ, EJ or JE and its associated services (e.g., A0425) across the provider community in Texas. For additional information on the Medical Review results, refer to the following notice: Non-Emergency Ambulance Transport Billed With Modifiers JN, NJ, EJ and JE Medical Review Results.

Based on the results of this review, TrailBlazer will implement a service-specific audit for ambulance services in Texas billed with modifiers EJ, JE, NJ and JN. This audit will be effective on or about July 1, 2011.

For additional information, refer to the “Utilization Guidelines” section in the Ambulance Local Coverage Determination (LCD) posted on our Web site.

Consider yourselves warned if you are in the Ambulance Business . . .

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