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

An Advance Beneficiary Notice (ABN) must be given to Medicare patients before transport when the service may not be covered due to lack of medical necessity, informing them of potential cost liability.

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

Medicare's closest appropriate facility rule states that reimbursable mileage is limited to the distance to the nearest facility capable of providing the necessary level of care for the patient's condition.

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

A thorough clinical description of the patient's physical or mental condition that prevents safe transport by wheelchair van, private vehicle, or other means is the core documentation needed to establish medical necessity.

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 clean claim is one that contains all required fields, correct coding, appropriate modifiers, and supporting PCR documentation, allowing the payer to process it without requesting additional information.

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

Under Medicare assignment, the ambulance service agrees to accept the Medicare-approved amount as payment in full and cannot balance-bill the patient beyond their cost-sharing amounts.

CADS - Certified Ambulance Documentation Specialist Practice Test

CADS - Certified Ambulance Documentation Specialist Practice Test

CADS CADS Ambulance Billing & Reimbursement 3