Tuesday, April 23, 2019

Quality to the Next Level


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Ambulance Services

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1-962002084 - Thursday, May 16, 2013

Rationale for the Referral: In order for nonemergency, scheduled, repetitive ambulance services to satisfy section 1861(s)(7) of the Social Security Act, physician certification requirements articulated in 42 C.F.R. §§  410.40(d)(1) and 410.40(d)(2) must be met.

Referral Document

Appeals Council Decision

 
1-787200734 - Friday, February 22, 2013
Rationale for the Referral: Regulations require that ambulance transport be prompted by a documented medical need.  Therefore, in order to comply with the regulations, the beneficiary's medical condition must require both the ambulance transportation itself and the level of service provided.

Referral Document

Appeals Council Decision


 
1-790268628 - Tuesday, June 5, 2012
Rationale for the Referral: Medicare does not pay separately for Basic Life Support (BLS) routine supplies, because payment for these services is included in the base rate for BLS ground ambulance transportation. See 42 C.F.R. § 414.605; 42 C.F.R. § 414.610(d); Medicare Claims Processing Manual (CMS Pub 100-4), Chapter 15, § 20.1.1.

Referral Document

Appeals Council Decision


 
1-818846781 - Tuesday, June 5, 2012
Rationale for the Referral: When a claim for ambulance mileage is denied because the destination hospital was not the closest appropriate facility, the limitation on liability provision of 1879 of the Act does not apply to limit liability for the denied mileage costs.

Referral Document

Appeals Council Decision

 
1-784906086 - Monday, December 5, 2011

Rationale for the Referral: Medicare Part A inpatient hospital services include transportation by ambulance.  Therefore, ambulance transportation is not separately payable when furnished to a beneficiary during an inpatient stay in an acute care hospital. 

Referral Document

Appeals Council Decision

 
1-765507227 - Wednesday, November 2, 2011

Rationale for the Referral: Oxygen, oxygen supplies, and related services may not be billed separately when basic life support ground ambulance transportation is furnished. The Medicare definition of basic life support ground ambulance transportation includes medically necessary supplies and services, which encompass oxygen, oxygen supplies, and related services.

Referral Document

Appeals Council Decision

 
1-791627923 - Friday, October 14, 2011

Rationale for the Referral: Where ambulance services are denied because other means of transportation are not contraindicated, denial is based on section 1861(s)(7) of the Social Security Act and section 1879 of the Social Security Act is not applicable to waive a beneficiary’s liability.

Referral Document

Appeals Council Decision

 
  
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