Avoiding Denials of Ambulance Services

Recently CMS published Medicare Fee-for-Service (FFS) improper payment date for ambulance services for the 2020 reporting period. For this reporting period, the improper payment rate for ambulance services was 7.2 percent, with a projected improper payment amount of $349 million. As per the findings, insufficient documentation accounted for 62.5 percent of improper payments for ambulance […]

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Role of States in Exclusion of Ground Ambulances from NSA

Exclusion of Ground Ambulances from No Surprises Act The No Surprises Act (NSA) will prohibit most surprise bills, reducing out-of-pocket costs for emergency services and non-emergency services where the patient unintentionally sees an out-of-network provider. The recently enacted No Surprises Act (NSA) provides landmark protections against surprise billing in a wide range of settings but […]

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Medicare requirements for ambulance transport medical billing

Today various private and public ambulance transport services are operating in a huge number for servicing critical patients at crucial moments. These players are getting reimbursed under Medicare Part B which covers ambulance transport medical billing with certain limitations. Let’s understand Medicare Part B in more details: Medicare Part B Medicare Part B covers emergency […]

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QN Modifier in Ambulance Transportation – you ought to know

For Medicare, modifiers are 2-digit codes that are appended to procedural codes and HCPCS codes. These modifiers are used to give more details about the billed procedure. The addition of modifiers in a claim can directly impact payment. You can get a list of modifiers on the internet at any time where you will get […]

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Extension of Prior Authorization for Repetitive, Scheduled Non-Emergent Ambulance Transports

Federal Register announced in their notice that a 1-year extension of the Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport. The extension of this model is applicable in certain states only. Earlier in those states, ambulance suppliers must obtain prior authorization from Medicare before providing scheduled, non-emergency ambulance transportation. These states are: Delaware […]

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Ambulance Transportation CPT Codes and Modifiers

Ambulance transportation services that are covered in Medicare part B covers ground ambulance transportation when a patient needs to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services while the transportation in another vehicle could be hazardous for patient’s health. However, ambulance transportation has certain risks. The risk […]

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Emergency Use Authorization of Medical Products

Recently, the Secretary of the Department of Health and Human Services (HHS) determined, according to section 564 of the Federal Food, Drug and Cosmetic (FD&C) Act, that there is a public health emergency, which has a serious potential to influence the health as well as the national security of citizens of the U.S. staying in other […]

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Avoid Common Errors in Ambulance Transportation Billing

An ambulance is a part of Emergency Medical Services (EMS), which is a billable event and most of the insurance companies such as Medicaid and Medicare compensate for it. Billing and coding for ambulance services may be complex owing to different modes of transportation like air, water, and ground. Apart from this, reimbursement of ambulance […]

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Ambulances: CMS Flexibilities to Fight COVID-19

The Trump Administration is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Made possible by President Trump’s recent Ambulance emergency declaration and emergency rulemaking, these temporary changes will apply immediately across the entire U.S. […]

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Medicare Coverage for DSMT Benefit

The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), under certain conditions. Becoming familiar with the Medicare DSMT reimbursement guidelines can help increase a DSMES service’s financial sustainability. Medicare Part B (medical insurance for outpatient care, preventive services, Ambulance Billing Services, and durable medical equipment) covers […]

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