Charges for ambulance transportation must prove to be medically necessary and reasonable to be reimbursed by Medicare.
"Ambulance services must be medically necessary and reasonable" to qualify for reimbursement, according to Medicare's billing and payment regulations. Medicare payments to emergency medical services are also based upon a patient's eligibility for care, as well as other provisions as described by the Center for Medicare and Medicaid Services (CMS). In general, payment is based on the level of service rendered, not the vehicle used to transport the patient. Mileage, however, is reimbursed separately.
Payment Criteria for Vehicle and Crew
To be fully reimbursed by Medicare for services, an ambulance must meet state license requirements and be equipped to transport patients with acute medical conditions, as well as be equipped and staffed to respond to medical emergencies. Medicare payments are made for all reasonable patient equipment and supplies carried on the ambulance.
To qualify for payment, a basic life support (BLS) ambulance is required to have a certified emergency medical technician (EMT) on board and at least one other crew member. An advanced life support ambulance (ALS) is required to have two crew members on board, one of whom must be certified as an EMT intermediate or paramedic
Destination Regulations
Billing regulations for mileage for ambulance services stipulate that only the mileage to the closest care facility equipped to treat the patient's needs is eligible for coverage. Care facilities include hospitals, nursing facilities, dialysis facilities and the patient's home. Physicians' offices are not eligible for mileage reimbursement. In general, only local destinations are covered under Medicare.
Billing Guide
The CMS billing guide defines the type of transportation, as well as the personnel necessary to transport a patient, to determine payment. Ground ambulance services must be considered medically necessary to qualify for Medicare payment. Some categories of ground ambulance services include basic life support (BLS) non-emergency, BLS emergency, advanced life support (ALS) levels 1 and 2, both emergency and non-emergency, as well as specialty care transport (SCT). Each category requires a specific level of EMS staffing and equipment. Billing procedures require proper identification and coding for each ground ambulance transportation category. Mileage is billed separately.
Billing Process
The billing process is typically submitted electronically. Medicare Specific Companion Document, Part B software should be used when submitting claims. This software includes codes, calculations and formulas for determining appropriate charges and payment. In addition, a medical conditions list describing the patient's condition, along with a physician certification statement certifying the patient's need for ambulance transportation, is required for billing purposes.
Tags: life support, ambulance transportation, medically necessary, advanced life, advanced life support
