Before we dive into the basics of air ambulance transportation billing, let’s understand basics of air ambulance transportation. Air ambulances are typically used to transport patients from the scene of an injury or an accident to hospitals, or between hospitals, particularly in critical situations when the time to treatment is urgent or when patients cannot safely travel by ground ambulance transportation. While the number of air ambulance transports is low, roughly 1 per 4,000 privately insured people per year and 1 in 350 Medicare beneficiaries.
Available evidence suggests there has been an increase in bases and providers/suppliers in recent years and a shift towards for-profit entities. Medically appropriate air ambulance transportation is a covered service regardless of the State or region in which it is rendered. However, Medicare (A/B MACs) approve claims only if the beneficiary’s medical condition is such that transportation by either basic or advanced life support ground ambulance is not appropriate.
There are two categories of air ambulance services: fixed wing (airplane) and rotary wing (helicopter) aircraft.
Fixed wing air ambulance is furnished when the beneficiary’s medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by fixed wing air ambulance may be necessary because the beneficiary’s condition requires rapid transport to a treatment facility, and either great distances or other obstacles, e.g., heavy traffic, preclude such rapid delivery to the nearest appropriate facility. Transport by fixed wing air ambulance may also be necessary because the beneficiary is inaccessible by a ground or water ambulance vehicle.
Rotary wing air ambulance is furnished when the beneficiary’s medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by rotary wing air ambulance may be necessary because the beneficiary’s condition requires rapid transport to a treatment facility, and either great distances or other obstacles, e.g., heavy traffic, preclude such rapid delivery to the nearest appropriate facility. Transport by rotary wing air ambulance may also be necessary because the beneficiary is inaccessible by a ground or water ambulance vehicle.
Air ambulance transportation services, either by means of a helicopter or fixed wing aircraft, may be determined to be covered only if:
Additionally, 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. In such a circumstance, the allowed amount is the appropriate air base rate, i.e., fixed wing or rotary wing. However, no amount shall be allowed for mileage or for a rural adjustment that would have been allowed had the transport of a living beneficiary or of a beneficiary not yet pronounced dead been completed.
Any vehicle used as an ambulance must be designed and equipped to respond to medical emergencies and, in nonemergency situations, be capable of transporting beneficiaries with acute medical conditions. The vehicle must comply with State or local laws governing the licensing and certification of an emergency medical transportation vehicle. At a minimum, the ambulance must contain a stretcher, linens, emergency medical supplies, oxygen equipment, and other lifesaving emergency medical equipment and be equipped with emergency warning lights, sirens, and telecommunications equipment as required by State or local law. This should include, at a minimum, one 2-way voice radio or wireless telephone.
Air ambulance transport is covered for transfer of a patient from one hospital to another if the medical appropriateness criteria are met, that is, transportation by ground ambulance would endanger the beneficiary’s health and the transferring hospital does not have adequate facilities to provide the medical services needed by the patient. Examples of such specialized medical services that are generally not available at all type of facilities may include but are not limited to: burn care, cardiac care, trauma care, and critical care. A patient transported from one hospital to another hospital is covered only if the hospital to which the patient is transferred is the nearest one with appropriate facilities. Coverage is not available for transport from a hospital capable of treating the patient because the patient and/or the patient’s family prefer a specific hospital or physician.
Knowledge of air ambulance transportation billing is crucial due to large balance bills for privately insured and uninsured patients. Medical Billers and Coders (MBC) is a leading medical billing company and can provide complete assistance for ambulance billing. Our expert billing and coding team ensures that you will receive accurate insurance reimbursement for all submitted claims. To know more about our ambulance billing and coding services, email us at: info@medicalbillersandcoders.com or call us at: 888-357-3226.
