Tuesday, January 10, 2012

Beneficiary Signature Requirements for ambulance billing

Medicare requires the signature of the beneficiary or that of his representative for both the purpose of accepting assignment and submitting a claim to Medicare. If the beneficiary is unable to sign because of a mental or physical condition, the following individuals may sign the claim form on behalf of the beneficiary: 

 The beneficiary’s legal guardian.
 A relative or other person who receives Social Security or other governmental benefits on behalf of the beneficiary.
 A relative or other person who arranges for the beneficiary’s treatment or exercises other responsibility for his affairs.
 A representative of an agency or institution that did not furnish the services for which payment is claimed, but furnished other care, services or assistance to the beneficiary. 
· A representative of the provider or of the non-participating hospital claiming payment for services it has furnished if the provider or non-participating hospital is unable to have the claim signed in accordance with 42 CFR 424.36(b) (1–4). 
 A representative of the ambulance provider or supplier who is present during an emergency and/or non-emergency transport, provided that the ambulance provider or supplier maintains certain documentation in its records for at least four years from the date of service.

A provider/supplier (or his employee) cannot request payment for services furnished except under circumstances fully documented to show that the beneficiary is unable to sign and that there is no other person who could sign. 
Medicare does not require that the signature to authorize claim submission be obtained at the time of transport for the purpose of accepting assignment of Medicare payment for ambulance benefits. When a provider/supplier is unable to obtain the signature of the beneficiary or that of his representative at the time of transport, the provider/supplier may obtain this signature any time prior to submitting the claim to Medicare for payment. 
If the beneficiary/representative refuses to authorize the submission of a claim, including a refusal to furnish an authorizing signature, the ambulance provider/supplier may not bill Medicare but may bill the beneficiary (or his estate) for the full charge of the ambulance items and services furnished. If, after seeing this bill, the beneficiary/ representative decides to have Medicare pay for these items and services, a beneficiary/representative signature is required and the ambulance provider/supplier must afford the beneficiary/representative this option within the claims filing period.

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