Monday, October 11, 2010

payment policy of more than one ambulance vehicale used

B. More Than One Vehicle Used

If more than one vehicle is used in transporting the patient to their destination, jurisdiction of the claim lies with:
• The carrier serving the home base of the ambulance taking the patient on the first leg of the trip, on a trip to a distant institution more remote than the nearest appropriate facility; or
• The carrier serving the home base of the ambulance taking the patient on the final leg of the trip home, on a trip from an institution more remote than the nearest appropriate facility.
• If there is no claim for the final leg of the trip, the carrier serving the patient’s home area handles any resulting claims or disallowance actions.

Jurisdiction State to State

If only one vehicle is used to transport the patient from the point of initial pickup to the final destination, jurisdiction is with the carrier serving the point of origin, i.e., home station of the vehicle. This carrier has qualification information on the ambulance supplier and all other necessary details to adjudicate the claim.

EXAMPLE
A patient is picked up at John Hopkins Hospital in Baltimore, Maryland and transported to his/her home in Portland, Maine by an ambulance dispatched from the area of the patient’s home. The carrier serving the point of origin of the ambulance, NHIC, Part B carrier of the state of Maine, has jurisdiction of any claim filed. In this case NHIC should have all the data necessary to make proper payment, i.e. certification of the ambulance company, price information and data pertaining to the nearest appropriate facility. Had an ambulance whose home station was in Baltimore been used, the carrier servicing Baltimore, Maryland would have jurisdiction.

No comments:

Post a Comment

Popular Posts