Other Methods of Transportation are Contraindicated Medical Necessity Defined We talk a lot about Medical Necessity in the ambulance billing office. Medical necessity and Reasonableness are key in determining whether or not an insurance payer is obligated to pay for ambulance transport, especially for Medicare and Medicaid patients. Title XVIII of the Social Security Act […]
Dissecting “The Misunderstoods”- Part II- Billing for SCT “The Misunderstoods” There are two level of service categories that we lump into a bucket called “The Misunderstoods” of ambulance billing. Two weeks ago we blogged about the Advanced Life Support, Level 2 (ALS2) level. Today, in Part II, we focus on the Specialty Care Transport or […]
Documenting Non-Emergency Scenarios Post October 1, 2015 Back Again We’re back again in the second part of our look at the guidance provided by Novitas Solutions as published in their future Local Coverage Determination (LCD) slated to begin on October 1, 2015. You’ll recall that we focused on emergency documentation in this space, last week. […]
CMS Releases Further Clarification and Guidance about Prior Authorizations Here to Stay The Centers for Medicare and Medicaid Services (CMS) Prior Authorization Demonstration Project is here to stay. Put in place by CMS as a pilot project in the States of New Jersey, Pennsylvania and South Carolina in December, 2014; the program requires that all […]
The Importance of Building and Maintaining Relationships Beyond EMS More and More… More and more we in EMS are being called upon to interact and develop relationships that go beyond our brothers and sisters in the Fire/EMS arena. It doesn’t matter what level of the organizational chart you serve, we all have a duty to […]
What the “Permanent Doc Fix” Means for EMS Yesterday Yesterday, March 26, 2015, the U.S. House of Representatives voted in favor of H.R. 2 to do away with Medicare’s sustainable growth-rate formula and to pass what is commonly known as the permanent doc fix. Uncertainty Remains While the House passed the measure overwhelmingly, there’s still […]
When Compassion and Compliance Collide New initiatives By now many of you, especially those of you who provide scheduled, routine, non-emergency transports (ie. Dialysis, radiation, etc.) are becoming aware of a new Medicare trial initiative for pre-authorizing approval for claims submitted for these types of transports. The Centers for Medicare and Medicaid Services (CMS) chose […]
The End to Medicare “Back Billing” Save the Date! Mark this date on your calendar- February 3, 2015. This is the date that sweeping and historic changes will take effect for the Medicare program. Late last week, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on the Medicare Incentive Program and […]
CMS Releases 2015 Zip Code Changes Affecting Ambulance Bonus Payments AAA Challenges CMS-Revisions Possible Change Announced Last week the Centers for Medicare and Medicaid Services (CMS) released the final rule that sets in motion a significant shift in the way that geographical areas are determined to identify urban versus rural areas for ambulance fee schedule […]
The “Continuous Monitoring” Factor for Inter-facility, Non-emergency Ambulance Transports From the Open Door Forum One of the staples of being an ambulance biller is religiously following any information provided by the Center for Medicare and Medicaid Services (CMS). Ambulance billers can easily follow CMS by participating in the Ambulance Open Door Forum audio-conferences. The Open […]
