CADS Ambulance Billing & Reimbursement Flashcards

Under Medicare, which level of ambulance service requires documentation of at least one ALS intervention or ALS assessment?

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.

Which federal regulation governs the Medicare medical necessity requirements for ambulance transport documentation?

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.

What is the primary purpose of the Physician Certification Statement (PCS) in ambulance billing?

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.

Which modifier is appended to ambulance HCPCS codes to indicate the transport originated at the scene of an accident?

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.

Under Medicare's ambulance fee schedule, mileage for loaded transport is reimbursed per what unit?

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.

Which HCPCS modifier combination indicates a transport from a scene to a hospital?

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.