Thursday, October 28, 2010

sheduled transport - physician certification statement time frame - ambulance billing

Scheduled is defined as transports arranged more than 24 hours prior to patient transports.
Non-Scheduled is defined as those transports scheduled less that 24 hours in advance.

Note: Patients residing in a facility not under the active care of a physician or those beneficiaries residing at home would not require physician certification statements for non-emergency non-scheduled ambulance services.

The physician certification statement for any transportation other than a non-emergency repetitive, scheduled transport may be completed and signed by the following medical professionals:

• The patient’s attending physician (MD or DO);
• Physician Assistant (PA);
• Nurse Practitioner (NP);
• Clinical Nurse Specialist (CNS);
• Register Nurse (RN); or
• A discharge planner employed by the hospital or facility where the beneficiary is treated, with knowledge of the beneficiary’s condition at the time the transport was ordered or the service was rendered.

CMS does not require a particular form or format for the certification. Suppliers and physicians may develop a certification form. Suppliers may use computer-generated PCS forms and computerized physician signatures to meet the PCS requirements. The written order (regardless of the format used) must be completed by the attending physician or specific professionals listed above. Ambulance company employees must not complete forms on behalf of these individuals.

The physician certification statement may include the expected length of time ambulance transport would be required. The following chart describes when certification is required.

Nature of Transport  Physician Certification Statement Required  Time Frame

Non-Emergency Repetitive Scheduled Yes No earlier than 60 days
Non Emergency Non-Repetitive – Scheduled Yes Within 48 hours
Non Emergency Services – Non Scheduled - Under direct Care of a Physician Yes Within 48 hours
Non Emergency Services – Non Scheduled - Not under direct care of a Physician No Not Required

Suppliers are not required to submit the physician certification statements with the claims. In all cases, the certification and appropriate documentation must be kept on file and, upon request, presented to the carrier. The presence or absence of the physician certification statement does not necessarily prove or disprove whether the ambulance was medically necessary.

Physician certification would not be required when an ambulance service is downgraded by the carrier from an emergency to non-emergency services. For non-emergency ambulance services that are either non scheduled or that are scheduled on a non-repetitive basis, providers/suppliers must obtain a written order from the attending physician within 48 hours of the transport. If unable to obtain a written order from the attending physician within 48 hours, providers/suppliers may submit a claim for the service if a PCS or certificate from an acceptable alternative person has been obtained or after 21 days if acceptable documentation of attempts to obtain the certification has been obtained.
Documentation of the attempt must include a signed return receipt from a US Postal Service or other similar delivery service. The receipt will serve as proof that the supplier attempted to obtain the required signature from the attending physician.

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