- General medical transport — this is provided for non-emergency and inter-facility transports that are considered medically necessary and non-emergent, such as trips to and from a variety of treatment centers (i.e., dialysis, cancer treatment, physicaltherapy, and/or outpatient clinics).
DETERMINING IF YOUR PATIENT MEETS THE
CRITERIA FOR AMBULANCE TRANSPORT
Establish Medical Necessity
o Patient is to be transported in an emergency situation as a result of an accident, injury, or acute illness;
o Patient needs to be restrained;
o Patient is unconscious or in shock;
o Patient requires oxygen or other emergency treatment on the way to the destination;
o Patient has to remain immobile because of a fracture that has not been set or the possibility of a fracture;
o Patient sustains an acute stroke or myocardial infarction;
o Patient is experiencing severe hemorrhaging;
o Patient has a condition that makes them bed-confined before and after the ambulance trip;
o Patient condition requires them to be moved ONLY by stretcher (i.e., fetal positioning, severe incapacitation, vegetative state).
Is The Patient Bed-Confined?
There is now a national definition of the term "bed-confined". Please note that is not synonymous with "bed rest" or "non-ambulatory". In addition, "bed confined" status is not the only criteria to be used in determining if the patient must be transported by ambulance. It is one factor to be considered when making coverage determinations.
"BED-CONFINED" is defined as:
a. Unable to get up from bed without assistance
b. Unable to ambulate
c. Unable to sit in a chair or wheelchair (unrestrained)
Is This An Emergency Transport?
The term "EMERGENCY" relates to "services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of such severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result" in any of the following:
a. Placing the patient's health in serious jeopardy;
b. Serious impairment to bodily functions; and/or
c. Serious dysfunction of any bodily organ or part
Is This A Non-Emergency Transport?
Any ambulance transport that meets the following criteria is considered non-emergent and will require the use of a Physician's Certification Statement (PCS), or more commonly known as a Certificate of Medical Necessity (CMN), at the time of transport:
a) All SCHEDULED transports (regardless of the origin and destination, including outpatient services or physician services);
b) Discharges to long term care centers, rehabs, nursing homes, skilled nursing units, or the patient's residence; and
c) Transports to and from ESRD facilities for maintenance dialysis
PHYSICIAN CERTIFICATION STATEMENTS:
For scheduled and unscheduled non-emergency ambulance transports, Medicare requires ambulance suppliers to obtain a physician's written order certifying the need for an ambulance prior to the transport. This form is commonly known as a PCS or CMN. These forms can be provided to you at no charge. Simply contact our office @ (334) 265-1208, and advise us where we should make the delivery. The form must contain the following information:
- be patient specific;
- contain pertinent medical information in order to determine medical necessity;
- confirm or support the medical information submitted by the transporting EMT / Paramedic, and;
- be signed and dated by authorized personnel such as the Physician, PA, CNS, NP, RN, or Discharge Planner who has knowledge of the patient's condition at the time of transport.
Our team of highly trained Business Office Staff are available (they can be reached at 334-241-5221) for all your questions and needs regarding patient benefits. Through training, we ensure that not only your staff is up-to-date on the latest information, but that your patient will receive the maximum reimbursement benefits due to them.