Wednesday, December 8, 2010

ambulance billing - Multiple Patients Transported Simultaneously

Multiple Patients Transported Simultaneously

When more than one patient is transported in an ambulance, the Medicare allowed charge for each beneficiary is a percentage of the allowed charge for a single beneficiary transport. The applicable percentage is based on the total number of patients transported, including both Medicare beneficiaries and non-Medicare patients.

If two patients are transported at the same time in one ambulance to the same destination, the adjusted payment allowance for each Medicare beneficiary would equal 75% of the single-patient allowed amount applicable to the level of service furnished a beneficiary, plus 50% of the total mileage payment allowance for the entire trip.
If three or more patients are transported at the same time in one ambulance to the same destination, the adjusted payment for each Medicare beneficiary would equal 60% of the single-patient allowed amount, plus a proportional mileage allowed amount, i.e., the total mileage allowed amount divided by the number of all the patients onboard.
The fact that the level of medically necessary service among the patients may be different is not relevant to this payment policy. The percentage is applied to the allowed amount applicable to the level of service that is medically necessary for each beneficiary.
If a multi-patient transport includes multiple destinations, then the Medicare allowed amount for mileage depends upon whether it is for an emergency versus non-emergency transport.
For example:
• For an emergency ground transport, which includes BLS-E, ALS1-E, ALS2 and SCT, the mileage payment shall be based on the number of miles to the nearest appropriate facility for each patient, divided by the number of patients on board when the vehicle arrives at the facility. This formula applies cumulatively for beneficiaries who are the 2nd and 3rd patients to be delivered.

• For a non-emergency ground transport, which includes BLS and ALS1, the mileage payment shall be based on the number of miles from the point of pick up to the nearest appropriate facility for each beneficiary, divided by the number of beneficiaries on board at the point of pick up. This formula applies cumulatively for beneficiaries for multiple points of pick up. Mileage other than the mileage that would be incurred by transporting the beneficiary directly from the point of pick up to the nearest appropriate facility is not covered. Thus, for non-emergency transports, the extra mileage that may be incurred by having multi-destinations shall not be taken into account.

• If a Medicare beneficiary is furnished medically necessary supplies and the supplier bills supplies separately, then the allowed amount of the supplies is not subject to an apportionment for multiple patients. The allowed amount for supplies should be determined in the same manner as if the beneficiary was the only patient onboard the vehicle.

• For air transports the policy is the same as for emergency ground transports.

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