CADS CADS Ambulance Billing & Reimbursement 3

Question 1

Which document must an ambulance service obtain when a Medicare beneficiary does not meet medical necessity criteria but still requests transport?

Accepted Answer

Advance Beneficiary Notice (ABN)

Answer

HIPAA Authorization Form

Answer

Assignment of Benefits Form

Answer

Certificate of Medical Necessity

Question 2

Under Medicare ambulance billing, what is the 'closest appropriate facility' rule?

Accepted Answer

Medicare only reimburses transport to the nearest facility capable of treating the patient's condition

Answer

Patients must always be transported to their primary care physician's affiliated hospital

Answer

The closest facility by road distance must always be used

Answer

Medicare pays extra mileage for transports bypassing closer facilities

Question 3

Which element of ambulance documentation is most critical for supporting the 'unable to be transported by other means' criterion?

Accepted Answer

Detailed description of the patient's physical condition and mobility limitations

Answer

The patient's stated preference for ambulance transport

Answer

A physician's order on file at the facility

Answer

The time of day and availability of other transport options

Question 4

What is a 'clean claim' in the context of ambulance billing and documentation?

Accepted Answer

A claim submitted with all required data elements, no errors, and supporting documentation

Answer

A claim that has been audited and approved by a RAC contractor

Answer

A claim filed within 24 hours of the transport

Answer

A claim with zero balance after patient payment

Question 5

Which federal law prohibits an ambulance service from billing a patient beyond the Medicare-approved amount when the service accepts assignment?

Accepted Answer

Medicare's limiting charge rule under 42 CFR

Answer

EMTALA

Answer

HIPAA Privacy Rule

Answer

False Claims Act

Question 6

In ambulance billing, what is the significance of documenting the patient's 'chief complaint' accurately on the PCR?

Accepted Answer

It drives ICD-10 code selection and supports medical necessity for the level of service billed

Answer

It determines which crew certification level is required for the transport

Answer

It establishes the patient's eligibility for Medicare coverage

Answer

It sets the transport priority for dispatch purposes only