Requirements for Coverage
For ambulance services to be covered by Medicare, the following requirements must be met:
Actual transportation of the beneficiary occurs.
Services must be medically necessary and reasonable for the condition of the patient.
The condition of the patient would not allow transportation by other means.
A diagnosis must be on the claim or a detailed description of the patient’s condition at the time of transfer must be submitted with the claim or provided upon request to determine medical necessity.
Ambulance personnel should document their observations of the patient’s condition.
Transportation to a hospital from another hospital when a patient’s needs cannot be met at the first hospital and the patient is admitted to the second hospital.
Transportation is to an extended care facility or to the patient’s home.
Transportation is to the closest appropriate facilities.
Transportation is provided by an approved supplier/provider of ambulance services.
The transportation is not part of a Part A (in patient) service.
Medical Necessity
The following conditions may establish that the patient had to be transported by ambulance:
Patient is transported in an emergency situation; e.g., as a result of an accident or injury.
Patient needs to be restrained.
Patient is unconscious or in shock.
Patient requires oxygen or other emergency treatment on the way to the destination.
Patient must remain immobile because of a fracture or the possibility of a fracture that has not been set.
Patient sustains an acute stroke or myocardial infarction.
Patient is experiencing severe hemorrhaging.
Patient has a condition that requires him to be moved only by stretcher.
Patient has a condition that makes him bed-confined before and after the ambulance trip.
Medicare Ambulance billing. Ambulance billing codes, Air ambulance billing guide and reimbursement. How and what code to use for correct payment.
Wednesday, September 14, 2011
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