Emergency Ambulance Services: Regulations and Required Documentation Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) Provider Outreach and Education December 12, 2017 Emergency Ambulance Services: Regulations and Required Documentation Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) Provider Outreach and Education December 12, 2017 December 2017 3 Using On24 Widgets • Adjust volume using your computer speakers or headset. • Use your mouse to point, click, and open a widget December 2017 4 Disclaimer • The information provided in this presentation was current as of 12/12/2017. Any changes or new information superseding the information in this presentation will be provided in articles and resources with publication dates after 12/12/2017 posted on our website at www.PalmettoGBA.com/RR. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. • This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services • The Centers for Medicare & Medicaid Services (CMS) and the Railroad Retirement Board (RRB) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide . • This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. CPT codes, descriptors and other data only are copyright 2017 American Medical Association. All rights reserved. December 2017 5 Frequently Used Acronyms Acronym Description ADR Additional Documentation Request ALS Advanced Life Support BLS Basic Life Support CERT Comprehensive Error Rate Testing CFR Code of Federal Regulations CMS Centers for Medicare & Medicaid Services CR Change Request HCPCS Healthcare Common Procedure Coding System IOM Internet Only Manual MLN Medicare Learning Network MR Medical Review RRB OIG Railroad Board Office of Inspector General PCS Physician Certification Statement POP Point of Pick-up December 2017 6 Objectives At the end of this presentation you will be familiar with: • The basic Medicare benefit policy relating to ALS emergency ground ambulance transports (HCPCS Code A0427) • Medicare documentation guidelines and the required elements to support each transport • Frequent ambulance claim denial reasons • How to avoid documentation errors December 2017 7 Agenda • Medicare Ambulance Benefit Policy • Standards for All Transports • Medical Review – Additional Documentation Requests • Documentation • Medical Review Results • Resources • Questions and Answers December 2017 8 Medicare Ambulance Benefit Policy December 2017 9 A Transport Benefit Medicare’s benefit for ambulance services is a “transport” benefit – without a transport to a Medicare-covered destination, there is no Medicare billable service. December 2017 10 Medicare Ambulance Benefit Medicare Part B ambulance coverage is met only in the following conditions: • The transportation is not covered under Part A • The ambulance supplier meets all applicable vehicle, staffing, billing, and reporting requirements • The services are medically necessary based on the patient’s condition at the time of transport • A definite transport of the beneficiary has occurred • The beneficiary is transported to a Medicare- approved destination