CADS CADS Ambulance Billing & Reimbursement 1 — Questions and Answers
Question 1: Under Medicare, which level of ambulance service requires documentation of at least one ALS intervention or ALS assessment?
- ALS Level 1 (ALS1) (Correct answer)
- BLS Emergency
- ALS Level 2 (ALS2)
- Specialty Care Transport
Correct answer: ALS Level 1 (ALS1)
Medicare ALS Level 1 (ALS1) requires documentation that an ALS assessment was performed or at least one ALS intervention was provided by a qualified ALS crew member.
Question 2: Which federal regulation governs the Medicare medical necessity requirements for ambulance transport documentation?
- 42 CFR Part 410 (Correct answer)
- 45 CFR Part 164
- 29 CFR Part 1910
- 21 CFR Part 820
Correct answer: 42 CFR Part 410
42 CFR Part 410 establishes the Medicare conditions for coverage of ambulance services, including the medical necessity and documentation requirements for reimbursement.
Question 3: What is the primary purpose of the Physician Certification Statement (PCS) in ambulance billing?
- To certify medical necessity for non-emergency transports (Correct answer)
- To document the patient's consent for treatment
- To authorize ALS interventions by paramedics
- To verify insurance eligibility at the time of transport
Correct answer: To certify medical necessity for non-emergency transports
A Physician Certification Statement (PCS) is required for Medicare non-emergency ambulance transports to certify that the transport was medically necessary and the patient's condition required ambulance transport.
Question 4: Which modifier is appended to ambulance HCPCS codes to indicate the transport originated at the scene of an accident?
- SH (Correct answer)
- RH
- SE
- SN
Correct answer: SH
The 'SH' modifier (scene of accident to hospital) is appended to ambulance HCPCS codes when the transport originated at the scene of an accident or acute event.
Question 5: Under Medicare's ambulance fee schedule, mileage for loaded transport is reimbursed per what unit?
- Per loaded mile (Correct answer)
- Per kilometer
- Per 5-mile increment
- Per transport regardless of distance
Correct answer: Per loaded mile
Medicare reimburses ambulance mileage on a per loaded mile basis, meaning only the miles driven while the patient is in the ambulance are reimbursable.
Question 6: Which HCPCS modifier combination indicates a transport from a scene to a hospital?
- SH (Correct answer)
- HH
- EH
- SE
Correct answer: SH
The HCPCS modifier 'SH' (Scene to Hospital) is the standard modifier indicating the ambulance transported the patient from the scene of an emergency to a hospital facility.
CADS CADS Ambulance Billing & Reimbursement 1
Under Medicare, which level of ambulance service requires documentation of at least one ALS intervention or ALS assessment?