Monday, January 17, 2011

Air ambulance billing and Medicare coverage

Air Ambulance

Medicare allows payment for an air ambulance service when the air ambulance takes off to pick up a Medicare beneficiary, but the beneficiary is pronounced dead before being loaded onto the ambulance for transport (either before or after the ambulance arrives on the scene). This is provided the air ambulance service would otherwise have been medically necessary. The allowed amount is the appropriate air base rate, i.e.; fixed or rotary wing. No amount is allowed for mileage or rural adjustment.

No payment is allowed if the dispatcher received pronouncement of death and had a reasonable opportunity to notify the pilot to abort the flight. The supplier must submit documentation with the claim sufficient to show that:

• The air ambulance was dispatched to pick up a Medicare beneficiary;
• The aircraft actually took off to make the pickup;
• The beneficiary to whom the dispatch relates was pronounced dead before being loaded onto the ambulance for transport;
• The pronouncement of death was made by an individual authorized by State law to make such pronouncements; and
• The dispatcher did not receive notice of such pronouncement in sufficient time to permit the flight to be aborted before take off.

As a general guideline, when it would take a ground ambulance 30-60 minutes or more to transport a member whose medical condition at the time of pick-up required immediate and rapid transport due to the nature and/or severity of the member’s illness/injury, air transportation may be appropriate. Air ambulance transportation should meet the following criteria:

 * The patient’s destination is an acute care hospital, and 

 * The patient’s condition is such that the ground ambulance (basic or advanced life support) would endanger the member’s life or health, or

 * Inaccessibility to ground ambulance transport or extended length of time required to transport the patient via ground ambulance transportation could endanger the member, or

 * Weather or traffic conditions make ground ambulance transportation impractical, impossible, or overly time consuming. Refer to #4 (Medicare Benefit Policy Manual) in the References section below.

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