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

Condition code QL indicates the patient was pronounced dead after the ambulance was en route, which affects how the claim is processed and reimbursed.

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

Medicare's Ambulance Fee Schedule uses three geographic categories — urban, rural, and super-rural — each with different percentage adjustments to the national base rate.

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

When Medicare is the secondary payer, the biller must first obtain an explanation of benefits (EOB) from the primary insurer and include it with the Medicare secondary claim.

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

Medicare generally does not reimburse treat-and-release calls without transport because coverage requires transport to a Medicare-approved destination.

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

CMS administers Medicare enrollment for ambulance suppliers through the PECOS system and the NPI is assigned through the National Plan and Provider Enumeration System (NPPES).

(CAC) Certified Ambulance Coder Practice Test

(CAC) Certified Ambulance Coder Practice Test

CAC CAC Medicare Coverage and Medical Necessity for Ambulance Transport 3