Emergency Ambulance Services: Regulations and Required Documentation Webcast - Questions and Answers

The following questions were answered during our December 12, 2017, webcast.

Question: I cannot hear anything but would like to know what do we need to do for rural hospital to hospital pick up over 100 miles away?

Answer: Can you provide more information to clarify this question?

Response Question: Rural hospital is over 100 miles from, say the heart hospital a patient has to go to, how is this billed for payment?

Answer: Medicare pays for mileage that is to the appropriate facility. Look at Section 10.3.3 on the CMS website (PDF, 400 KB).

Answer 2: Transportation of a beneficiary (who is not in a Part A admission), is covered by Part B Medicare if the transport meets the coverage criteria. For a patient requiring specialty care that is not available at the rural hospital, Part B will cover the base transport and mileage to the closest hospital capable of furnishing the medically necessary care. Mileage is not covered for a facility beyond the closest facility capable of providing care.

The fact that a particular physician does or does not have staff privileges in a hospital is not a consideration in determining whether the hospital has appropriate facilities. Thus, ambulance service to a more distant hospital solely to avail a patient of the service of a specific physician or physician specialist does not make the hospital in which the physician has staff privileges the nearest hospital with appropriate facilities.

The fact that a more distant institution is better equipped, either qualitatively or quantitatively, to care for the patient does not warrant a finding that a closer institution does not have “appropriate facilities.” Such a finding is warranted, however, if the beneficiary’s condition requires a higher level of trauma care or other specialized service available only at the more distant hospital.

Charges for mileage must be based on loaded mileage only, i.e., from the pickup of a patient to his/her arrival at destination. It is presumed that all unloaded mileage costs are taken into account when a supplier establishes their basic charge for ambulance services and their rate for loaded mileage. Suppliers should be notified that separate charges for unloaded mileage will be denied.


Question: Why can we not get items such as oxygen or IV supplies paid for as they are costly to an ambulance provider?

Answer: Please visit the CMS website (PDF, 410 KB). This link provides guidance on covered services in section 10.4 — The cost of oxygen and its administration in connection with and as part of the ambulance service is covered. Under the ambulance Fee Schedule (FS), oxygen and other items and services provided as part of the transport are included in the FS base payment rate and are not separately payable.

Question: Are the "Subscription Plans" where folks pay on a monthly utility bill so they do not have to pay what Medicare deems patient responsibility, are these plans legal?

Answer: In regard to the "Subscription Plan," this is not a Medicare insurance plan. Please contact the entity issuing the policy to determine if the plan is valid. We are not able to determine the validity of other plans.

Question: How do we go about getting changes so oxygen and supplies and such can be billed separately as it is more costly than the base rate covers? The subscription plan is not an insurance plan it is paying to the city so they drop patient responsibility.

Answer: It may be useful to attend the CMS Ambulance Open Door Forum and bring this subject up in the questions period. There you may hear an answer that would help you on this issue.

Regarding the question on subscription plans, we cannot address the legality of city fee-for-service billing of residents.
Question: Did you say we cannot bill Medicare patients separately for rescue charges? Such as someone injured while hiking on a trail?

Answer: The Medicare program ambulance fee schedule (FS) is effective for ambulance items and services as explained in the IOM 100-02, Chapter 10, Section 30 (PDF, 400 KB).

The fee schedule applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers, e.g., hospitals, skilled nursing facilities and home health agencies covered under Medicare Part B, except for services furnished by certain critical access hospitals (CAH).

By definition, Advanced Life Support, level 1 (ALS1) is the transportation by ground ambulance vehicle (as defined in section 10.1, in the reference above) and the provision of medically necessary supplies and services (as defined in section 10.2, in the reference above) including the provision of an ALS assessment by ALS personnel or at least one ALS intervention.

The Medicare guidelines specifically state the ambulance transport service covers all medically necessary supplies and crew services. Additionally, Medicare has a benefit for loaded mileage.

There is no extra Medicare benefit for other services by ambulance suppliers. All medically necessary treatment (both crew service and supplies) is bundled into the payment for the base rate.

Question: Nonemergency repetitive transports required to have prior authorization number like regular Medicare does require?

Answer: The RRB SMAC does not require a prior authorization number for non-emergent repetitive transports.

Question: Will this in-service be available for viewing later?

Answer: The event will soon be available as an on-demand archive version. You should receive an email as soon as it is ready. Thank you for your participation.

The event recording will be posted to our website within 10 days of this presentation. 

Note: By default the audience will be able to access the archive through the Audience URL 30 minutes after the webcast is complete.  The system post-event emails will include a link to the on demand webcast.

Question: Why is my CEU code invalid?

Answer: Palmetto GBA does not assign or grant CEUs. We do provide a course number which you can submit with a copy of the presentation to your organization. They may grant you a CEU credit based on the content. The course number for today's presentation is # RRB1548437

Question: Please define ALS.

Answer: Advanced Life Support

Question: Do we need to respond 45 days from the date of the letter or date of receipt of the letter?

Answer: The date on the letter.

Question: Do you have the course number for the certificate?

Answer: RRB1548437.

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