Friday, October 8, 2010

Medicare covereage - when Time of Death Pronouncement


There are three rules that apply to ambulance services and the pronouncement of death:

* If the beneficiary was pronounced dead by an individual who is licensed to pronounce death (coroner/physician) prior to the time that the ambulance is called, no payment is made.

* If the beneficiary is pronounced dead after the ambulance is called but before the ambulance arrives at the scene, payment for an ambulance trip is made at the BLS rate, but no mileage is paid.

* If the beneficiary is pronounced dead after being loaded into the ambulance, payment is made following the established program policies (that is, the same level of payment is made as if the beneficiary had not died).

Ground or Water

Medicare ambulance benefits are a transport benefit, if no transport of a Medicare beneficiary occurs, and then there is no Medicare covered service. In general, if the beneficiary dies before being transported, then no Medicare payment may be made. Thus in a situation where the beneficiary dies, whether any payment under the Medicare ambulance benefits may be made depends on the time at which the beneficiary is pronounced dead by an individual authorized by the State to make such pronouncements. The chart below shows the Medicare payment determination for various ground ambulance scenarios in which the beneficiary dies. In each case, the assumption is that the ambulance transport would have otherwise been medically necessary

Time of Death Pronouncement                            Medicare Payment Determination
Before dispatch                                                        No payment

After dispatch, before beneficiary is                  The ambulance BLS base rate is paid. No
loaded onboard the ambulance                            mileage or rural adjustment. Use the QL
(before or after arrival at the point of pickup).      modifier when submitting the claim

After pickup, prior to or upon arrival                    Medically necessary level of service
at the receiving facility.                                         furnished is allowed.

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