Date: September 20, 2019
To: Enrolled Transportation Providers; Hospitals; Long-Term Care Facilities; and State Operated Facilities
Re: Transportation Billing Reminders
This notice serves as a reminder to hospitals, long term care (LTC) facilities, state-operated facilities, and transportation providers that the Department may not be billed for transportation services uder the following scenarios.
Long Term Care (LTC) Facility Residents
When a transport to a service other than a covered medical service originates at a LTC facility, the Department should not be billed. Examples of non-covered services include, but are not limited to, transportation to a sheltered workshop, day training center, or from one LTC facility to another LTC facility. The transportation provider must verify the reimbursement source (i.e., the day training center, sheltered workshop or LTC facility) prior to transport.
When a hospital inpatient is transported to another medical facility for outpatient services not available at the hospital of origin and later transported back to the original inpatient hospital setting, the Department should not be billed. In this instance, the transportation provider must seek payment from the inpatient hospital.
State-Operated Facility Residents
Medical transportation provided for patients who reside in state operated facilities should not be billed to the Department. The transportation provider must seek payment from the state-operated facility.
As stated in the Transportation Handbook, Topic 204, transportation providers must work with the entity requesting the service to verify reimbursement sources prior to delivery of services, to allow for correct billing in these situations. Hospitals and long term care facilities are required to complete the HFS 2270 Physician Certification Statement (PCS) for all non-emergency transportation originating at a hospital or LTC facility, via ground ambulance, medicar/wheelchair van or service car transport. The PCS policy is outlined in provider notices dated November 21, 2018; February 15, 2019; April 26, 2019; and July 25, 2019.
Providers who fail to comply with the policies set forth in this notice may be subject to penalties if fraud, waste or abuse is determined.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service Medical Programs participants, or to the applicable HealthChoice Illinois managed care plan.