{"id":15577,"date":"2022-08-02T12:43:59","date_gmt":"2022-08-02T12:43:59","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15577"},"modified":"2025-07-22T08:58:25","modified_gmt":"2025-07-22T08:58:25","slug":"avoiding-denials-of-ambulance-services","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/avoiding-denials-of-ambulance-services\/","title":{"rendered":"Avoiding Denials of Ambulance Services"},"content":{"rendered":"\r\n<p class=\"wp-block-paragraph\">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.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">As per the findings, insufficient documentation accounted for 62.5 percent of improper payments for ambulance services. Additional types of errors for ambulance services were medical necessity (23.5 percent) and incorrect coding (10.8 percent). In this article, we shared guidelines that will help you in avoiding denials of emergency and non-emergent ambulance services.<\/p>\r\n\r\n\r\n\r\n<h2 style=\"text-align: left;\">Avoiding Denials of Emergency Ambulance Services<\/h2>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Medicare requires the following conditions for the patient to be eligible for ambulance services:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Approved supplier of ambulance services transported patients to or from a proper location.<\/li>\r\n\r\n\r\n\r\n<li>The patient suffered from an illness or injury, which contraindicated transportation by other means, and medically required ambulance services.<\/li>\r\n\r\n\r\n\r\n<li>We note bed confinement isn\u2019t the sole criterion in determining the medical necessity of ambulance transportation. We consider it 1 factor in medical necessity determinations.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Following scenarios highlight what Medicare Administrative Contractors (MACs) would presume medical necessity for both emergent and non-emergent ambulance services:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>You transported a patient in an emergency, for example, because of an accident, injury, or acute illness<\/li>\r\n\r\n\r\n\r\n<li>You needed to restrain the patient to prevent injury to the patient or others<\/li>\r\n\r\n\r\n\r\n<li>The patient required oxygen or other emergency treatment during transport to a nearest proper facility<\/li>\r\n\r\n\r\n\r\n<li>The patient was unconscious or in shock<\/li>\r\n\r\n\r\n\r\n<li>The patient showed signs and symptoms of acute respiratory distress or cardiac distress, such as shortness of breath or chest pain<\/li>\r\n\r\n\r\n\r\n<li>The patient showed signs and symptoms that show the possibility of acute stroke<\/li>\r\n\r\n\r\n\r\n<li>The patient needed to stay immobile because of a fracture that hadn\u2019t been set or the possibility of a fracture<\/li>\r\n\r\n\r\n\r\n<li>The patient experienced a severe hemorrhage<\/li>\r\n\r\n\r\n\r\n<li>A patient could be moved only by stretcher<\/li>\r\n\r\n\r\n\r\n<li>The patient was bed-confined before and after the ambulance trip<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<h2 style=\"text-align: left;\">Avoiding Denials of Non-Emergent Ambulance Services<\/h2>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Non-emergency transportation by ambulance is proper if either:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>The patient is bed-confined, and it\u2019s documented that the patient\u2019s condition contraindicates other methods of transportation<\/li>\r\n\r\n\r\n\r\n<li>Their medical condition, regardless of bed confinement, is such that transportation by ambulance is medically required<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">As a result, bed confinement isn\u2019t the sole criterion in determining the\u00a0<a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/ambulance-transportation-medical-billing-services.html\">ambulance transportation<\/a>\u00a0medical necessity. We consider bed confinement as 1 factor in medical necessity determinations. For us to consider the patient bed-confined, the patient must meet these criteria:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Can\u2019t get up from bed without help<\/li>\r\n\r\n\r\n\r\n<li>Can\u2019t ambulate<\/li>\r\n\r\n\r\n\r\n<li>Can\u2019t sit in a chair or wheelchair<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Special rules discuss non-emergency ambulance services that are either unscheduled or scheduled on a nonrepetitive basis. We cover medically necessary non-emergency ambulance services that are either unscheduled or scheduled on a nonrepetitive basis under 1 of these circumstances:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>For residents of a facility who are under the care of a physician, if the ambulance provider or supplier gets a physician certification statement within 48 hours after transport.<\/li>\r\n\r\n\r\n\r\n<li>For patient residing at home or in a facility who isn\u2019t under the direct care of a physician, we don\u2019t require physician certification.<\/li>\r\n\r\n\r\n\r\n<li>If you can\u2019t get a signed physician certification statement from the patient\u2019s attending physician, they must get a non-physician certification statement.<\/li>\r\n\r\n\r\n\r\n<li>If you can\u2019t get the required physician or non-physician certification statement within 21 calendar days following the date of service, you must document attempts to get the requested certification and may then send the claim.<\/li>\r\n\r\n\r\n\r\n<li>In all cases, the provider or supplier must keep documentation on file and, when asked, present it to the contractor. The physician\u2019s, or non-physician\u2019s, certification statement or signed return receipt doesn\u2019t alone show ambulance transport was medically necessary. We require you to meet all other program criteria for us to make a payment.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<h2 style=\"text-align: left;\">Signature Requirements<\/h2>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Medicare would require a patient\u2019s signature, or that of an authorized person to sign the claim form on behalf of the patient for you to send a claim. If the patient can\u2019t sign because of a mental or physical condition, these individuals may sign the claim form on behalf of the patient:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Patient\u2019s legal guardian<\/li>\r\n\r\n\r\n\r\n<li>Relative or other people who get Social Security or other governmental benefits on behalf of a patient<\/li>\r\n\r\n\r\n\r\n<li>Relative or other people who arrange for patient\u2019s treatment or exercise other responsibility for their affairs<\/li>\r\n\r\n\r\n\r\n<li>Representative of an agency or institution that didn\u2019t provide the service of the claims payment, but provided other care, services, or help to the patient<\/li>\r\n\r\n\r\n\r\n<li>Representative of provider or non-participating hospital claiming payment for services it provided, if the provider or non-participating hospital can\u2019t get a patient or representative to sign the claim under 42 CFR Section 424.36(b)(1\u20134)<\/li>\r\n\r\n\r\n\r\n<li>Your representative who\u2019s present during an emergency and or non-emergency transport if you keep certain documentation in your records for at least 4 years from the date of service. You (or your employee) can\u2019t ask for payment for services provided except under circumstances fully documented to show the patient can\u2019t sign and there\u2019s no other person who could sign.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Medicare covers ambulance services via ground transportation, as well as air ambulance services. This includes fixed wing and rotary wing ambulance services for patients when one shouldn\u2019t use other means of transportation. For billed services to be medically necessary, the patient\u2019s condition requires both ambulance transportation and the level of service.<\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><strong>MedicalBillersandCoders (MBC)<\/strong>\u00a0is a leading revenue cycle company providing complete medical billing services. For any assistance required for ambulance services, contact us at\u00a0<a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a>\/\u00a0<a href=\"tel:888-357-3226\">888-357-3226<\/a><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\">Reference:\u00a0Medicare Benefit Policy Manual, <a href=\"https:\/\/www.cms.gov\/Regulations-and-Guidance\/Guidance\/Manuals\/downloads\/bp102c10.pdf\">Chapter 10<\/a><\/p>\r\n\r\n\r\n\r\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.cms.gov\/files\/document\/2020-medicare-fee-service-supplemental-improper-payment-data.pdf\">2020 Medicare Fee-for-Service Supplemental Improper Payment Data<\/a><\/p>\r\n\r\n\r\n\r\n<h2>FAQs:<\/h2>\r\n\r\n\r\n\r\n<div class=\"schema-faq wp-block-yoast-faq-block\">\r\n<div id=\"faq-question-1753174419595\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">1. <strong>What was the improper payment rate for ambulance services in 2020?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">The improper payment rate for ambulance services was 7.2%, resulting in an estimated $349 million in improper payments, primarily due to insufficient documentation.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1753174479279\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">2. <strong>What conditions must be met for Medicare to cover emergency ambulance services?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">Patients must be transported by an approved supplier to a proper location and have a medical condition that requires ambulance services, preventing transportation by other means.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1753174495084\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">3. <strong>How can providers avoid denials for non-emergency ambulance services?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">Providers should document that the patient is bed-confined or that their medical condition requires ambulance transportation, as bed confinement alone is not sufficient for medical necessity.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1753174513344\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">4. <strong>What documentation is required for non-emergency ambulance services?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">A physician certification statement is needed for residents under a physician\u2019s care, while attempts to obtain this certification must be documented if it cannot be secured within 21 days.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1753174527453\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">5. <strong>Who can sign the claim form if the patient is unable to do so?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">Authorized individuals, such as legal guardians or family members, can sign on behalf of the patient if they are unable to due to mental or physical conditions.<\/p>\r\n<\/div>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":15578,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[869],"tags":[3590,3587,3588,596,51,3589,3507,3591],"class_list":["post-15577","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ambulance-transportation-billing-services","tag-ambulance-services","tag-avoiding-denials-of-ambulance-services","tag-avoiding-denials-of-emergency-and-non-emergent-ambulance-services","tag-claim-denials","tag-cms","tag-emergency-ambulance-services","tag-leading-revenue-cycle-company","tag-medicare-administrative-contractors-macs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Avoiding Denials of Ambulance Services<\/title>\n<meta name=\"description\" content=\"Learn about Avoiding Denials of Ambulance Services in our latest blog post. Medical Billing and RCM Blogs\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/avoiding-denials-of-ambulance-services\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Avoiding Denials of Ambulance Services\" \/>\n<meta property=\"og:description\" content=\"Learn about Avoiding Denials of Ambulance Services in our latest blog post. 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The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.\",\"sameAs\":[\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\"]},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/avoiding-denials-of-ambulance-services\\\/#faq-question-1753174419595\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/avoiding-denials-of-ambulance-services\\\/#faq-question-1753174419595\",\"name\":\"1. 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