CAC Medical Billing and Reimbursement for Ambulance Services — Questions and Answers
Question 1: Which of the following is a primary payer for ambulance services in the United States?
- Medicare (Correct answer)
- Private donations
- State police funds
- Housing and Urban Development grants
Correct answer: Medicare
Medicare is one of the largest payers for ambulance services, covering emergency and medically necessary non-emergency transports.
Question 2: What is the primary requirement for Medicare to reimburse non-emergency ambulance transport?
- The patient must sign a waiver
- The transport must be medically necessary (Correct answer)
- The ambulance must be operated by a private company
- The patient must have private insurance
Correct answer: The transport must be medically necessary
Medicare requires that the transport be medically necessary and that the patient cannot be safely transported by other means.
Question 3: Which billing code set is primarily used for ambulance services?
- CPT
- HCPCS Level II (Correct answer)
- ICD-10-CM
- SNOMED CT
Correct answer: HCPCS Level II
HCPCS (Healthcare Common Procedure Coding System) Level II codes are used to bill ambulance services and medical supplies.
Question 4: Which of the following must be documented to justify ambulance transport reimbursement?
- The patient’s home address
- The patient’s ability to pay
- The medical necessity of the transport (Correct answer)
- The number of emergency calls received that day
Correct answer: The medical necessity of the transport
Clear documentation of medical necessity, including the patient’s condition and the reason for transport, is required for reimbursement.
Question 5: Which modifier is typically used for emergency ambulance transport?
- NE
- EM (Correct answer)
- TX
- NC
Correct answer: EM
The modifier 'EM' is used to indicate emergency transport services for ambulance billing purposes.
Question 6: Why is prior authorization required for some non-emergency ambulance transports?
- To verify patient identity
- To confirm medical necessity before reimbursement (Correct answer)
- To document mileage
- To record dispatch times
Correct answer: To confirm medical necessity before reimbursement
Prior authorization ensures that the transport is medically necessary and meets coverage requirements before reimbursement is approved.
CAC Medical Billing and Reimbursement for Ambulance Services
Which of the following is a primary payer for ambulance services in the United States?