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Committee urges wider use of Medicaid 'treat-no-transport' code; GainWell training planned
Summary
GainWell and TAC members warned that only 28% of Medicaid-billing EMS providers have billed the treat-no-transport code since its 2023 start; members said billing training and outreach to directors and billing companies are needed to recover unclaimed revenue.
Members told the TAC that the Medicaid treat-no-transport billing code (available since Jan. 1, 2023) is underused and that failing to bill it means lost revenue for EMS services. A GainWell representative said, "as of, June of this year, only 28% of, all EMS providers that bill Medicaid have billed treat no transport," and added that far fewer claim associated supply reimbursements.
Speakers described cases where incorrect or never-resubmitted claims left millions of dollars unclaimed: the GainWell representative said a review of Martin County's billing found about $4,000,000 in potentially payable claims that were not recovered. Committee members and billing-company reps recommended that GainWell's Oct. 22 training include denial diagnosis, modifiers, and how to resubmit corrected claims; billing firms should be included on outreach so fixes are applied consistently.
Justin (GainWell) said the training will include MCO representatives so providers can see each plan's specific requirements and modifiers. A billing-company representative added that the community should "flood the market" with the training information and contact directors and billing vendors so the message reaches those who actually submit claims.
Provenance: topicintro SEG 471, topfinish SEG 664.
