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Pennsylvania Medicaid Mileage Policy

February 28, 2017
FROM:     Page, Wolfberg & Wirth, LLC (www.pwwemslaw.com)
RE:         Pennsylvania Medicaid Mileage Policy

Over the past few weeks, we have been contacted by a number of ambulance service providers and billing companies that were concerned about recent advice from the Ambulance Association of Pennsylvania (AAP) regarding mileage billing for Pennsylvania Medical Assistance (Medicaid). The current MA published policy regarding mileage billing is that DHS will only pay for patient loaded mileage beyond 20 miles, and that only loaded mileage can be factored in to reach the 20-mile threshold. This changes previous MA guidance which used to provide that reimbursement would be given for patient loaded miles after 20 miles and that loaded and unloaded mileage could be combined to get to the 20-mile threshold.

While we emphatically support the AAP’s goal of changing the PA Medicaid mileage policy, we were not consulted by the AAP as to its recent recommendation to bill claims inconsistent with the current published MA policy. We strongly recommend that Pennsylvania ambulance service providers and billing companies not follow the AAP recommendation of including unloaded mileage in the calculation of the first 20-mile threshold. Unless DHS changes this policy (which we strongly believe they should), unloaded mileage should not be used in any manner to calculate billable mileage to Pennsylvania Medicaid. Doing so could expose ambulance service providers to potential audits and investigations, potential overpayment demands, possible suspension of claim payments, or even allegations of submitting false claims.

Until there is a successful challenge to the current MA Policy, or the policy changes, we believe that it is best to follow the most recent MA Bulletin (26-15-01) and related Pennsylvania Bulletin Notices, the MA ambulance fee schedule, and guidance from the Pennsylvania Department of Human Services (DHS) that addresses billing for mileage. Compliance with the current MA Policy requires that only loaded mileage beyond the first 20 loaded miles travelled should be billed to the MA Program and that unloaded miles may not be factored into the calculation.   

We strongly disagree with the current MA Policy, and believe there may be valid arguments to challenge the current DHS policy and seek a change. But, nonetheless, it is the current, published payment policy until DHS changes it or a court rules otherwise. DHS administers and enforces the MA Program and billing in a manner that is contrary to published policy presents legal and compliance risks. 

Again, we do not recommend that any unloaded mileage be used to calculate mileage in any way for PA Medicaid claims. Indicating on a claim that unloaded mileage is being factored in “under protest” in our view does not absolve or protect the ambulance service provider from the potential compliance risks we described above, particularly in today’s very aggressive enforcement environment.
Ambulance service providers and billing companies who bill PA Medicaid are strongly advised to consult their legal counsel if they have any further questions or concerns on this issue. Feel free to contact PWW if you have any questions. 

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