CAC CAC Medicare Coverage and Medical Necessity for Ambulance Transport 3

Question 1

What is the significance of the condition code 'QL' on a Medicare ambulance claim?

Accepted Answer

Patient is pronounced dead after ambulance is called

Answer

Patient refused transport

Answer

Transport was non-emergency

Answer

Claim is for a cancelled transport

Question 2

Under the Medicare Ambulance Fee Schedule, how many Geographic Service Areas (urban, rural, super-rural) affect the ambulance base rate?

Accepted Answer

Three

Answer

Two

Answer

Four

Answer

Five

Question 3

When Medicare is secondary payer (MSP), what must the ambulance biller do before submitting to Medicare?

Accepted Answer

Submit to the primary insurer first and include the primary's payment or denial information with the Medicare claim

Answer

Submit only to Medicare as it is a federal program

Answer

Obtain a waiver of liability from the patient

Answer

Submit both claims simultaneously to avoid delays

Question 4

What is the Medicare coverage requirement for 'treat and release' or 'no transport' ambulance calls?

Accepted Answer

Generally not covered; Medicare requires actual transport to a covered destination

Answer

Covered if ALS services were provided

Answer

Covered if a physician authorizes on-scene treatment

Answer

Covered under the BLS base rate

Question 5

Which federal program oversees Medicare ambulance supplier enrollment and assigns the National Provider Identifier (NPI)?

Accepted Answer

CMS (Centers for Medicare & Medicaid Services)

Answer

FEMA

Answer

The Joint Commission

Answer

NHTSA

Question 6

What does the Medicare 'look-back' period for medical necessity documentation require for non-emergency ambulance transport?

Accepted Answer

Documentation must reflect the patient's condition at the time of transport, typically within 48 hours of the service date

Answer

Documentation must be from the previous 90 days

Answer

Documentation must be signed within 30 days post-transport

Answer

Documentation can be created retroactively at any time