Friday, May 20, 2016

Ambulance Services Requiring Medical Necessity

Medical necessity documentation (see Section 4100 of the General Special Requirements Provider Manual) must be attached to the claim form when billing for nonemergency transports, waiting time, multiple patients on one ambulance trip, and air ambulance transportation. When the beneficiary is Kansas Medical Assistance Program (KMAP) eligible plus qualified Medicare
beneficiary (QMB), and Medicare allows the service, medical necessity (MN) need not be attached to the claim. However, it must be available in the provider's file. The documentation must be printed and legible.

MN for nonemergency ambulance transportation must state the reason the trip is required (hospital discharge or medical service) and the medical reason the beneficiary could not be transported by car or van.

MN for air ambulance transportation must indicate the beneficiary's medical condition required immediate and rapid ambulance transportation that could not have been provided by land ambulance and one of the following:

** The point of pickup is inaccessible by land vehicle.

** Great distances or other obstacles are involved in getting the beneficiary to the nearest hospital with appropriate facilities.
** The beneficiary's condition is such that the time needed to transport by land, or the instability of transportation by land, poses a threat to the beneficiary's survival or seriously endangers the beneficiary's health.

If a determination is made that transport by ambulance was necessary, however, land ambulance service would have sufficed, payment for the air ambulance service will be the lesser of the billed charges and the maximum allowable for ground ambulance.

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