Widespread Probe Review Results for Iowa Providers Billing HCPCS A0426

Part A Medical Review has recently completed the prepay probe review of HCPCS A0426-Non Emergency ALS Transport. The topic for this review was 5140W. The claims were randomly selected across the provider community billing this service that met the parameters of the edit. The review results are as follows:

Providers Reviewed:                           9
Claims Reviewed:                             88
Claims Approved:                             63
Claims Denied:                                 25
Charges Reviewed:           $63,180.00
Charges Approved:           $48,537.50
Charges Denied:               $14,642.50
Error Rate:                                       23 percent

* Error rate is based on the charges denied divided by the charges reviewed

The medical review decisions were based on the local coverage determination (LCD) for Ambulance Service; L12792.

As a result of this prepayment probe review, no further action will be taken at this time.

Page last updated: Feb. 27, 2008