Ambulance Transportation Billing: Definitions

Ambulance Transportation Billing: Definitions

Ambulance transportation is a billable event. All insurance companies including Medicare and Medicaid both pay for Ambulance transportation service. Billing and coding for ambulance services is complex because of the unique and comprehensive modifiers. There are various modes of transport includes ground, water, emergency air ambulances. Medisys Data has certified ambulance transportation billers and coders.

As we discussed that AT billing for the services more difficult than for other providers, as a result documentation for an ambulance trip and appropriate coding is need to reported correctly because these are the key elements in identifying whether or not the service will be reimbursed.

Ambulance transportation (AT) reimbursement rates are varying based on the service provided to patient. Ambulance transportation billing and coding rigorously based on the documentation. The EMR systems can help AT providers to organize clinical documentation. Medisys Data has expertise in ambulance billing and a assurance to error free billing and coding and increased cash flow. To optimize ambulance transportation reimbursements, you need to make sure that your documentation is done well.

Ambulance Services Definitions

We have listed some definitions pertaining to payment and claim processing follow. Ref: CMS Regulations and Guidance

A/B MAC (A) Definition

The term refers to those contractors that process claims for institutionally-based ambulance providers billed on the ASC X12 837 institutional claim transaction or Form CMS-1450.

A/B MAC (B) Definition

The term refers to those contractors that process claims for ambulance suppliers billed on the ASC X12 837 professional claim transaction or a CMS-1500 form.

Date of Service Definition

The date of service (DOS) of an ambulance service is the date that the loaded ambulance vehicle departs the point of pickup. In the case of a ground transport, if the beneficiary is pronounced dead after the vehicle is dispatched but before the (now deceased) beneficiary is loaded into the vehicle, the DOS is the date of the vehicle’s dispatch. In the case of an air transport, if the beneficiary is pronounced dead after the aircraft takes off to pick up the beneficiary, the DOS is the date of the vehicle’s take-off.

Point of Pickup (POP) Definition

Point of pickup is the location of the beneficiary at the time he or she is placed on board the ambulance. Application: The ZIP Code of the POP must be reported on each claim for ambulance services so that the correct Geographic Adjustment Factor (GAF) and Rural Adjustment Factor (RAF) may be applied, as appropriate.

Provider Definition

For the purposes of this chapter only, the term “provider” is used to reference a hospital-based ambulance provider which is owned and/or operated by a hospital, critical access hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice program, or, for purposes of section 1814(g) and section 1835(e), a fund.

Supplier Definition

For the purposes of this chapter, the term supplier is defined as any ambulance service that is not institutionally based. A supplier can be an independently owned and operated ambulance service company, a volunteer fire and/or ambulance company, a local government run firehouse based ambulance, etc., that provides Part B Medicare covered ambulance services and is enrolled as an independent ambulance supplier.

Ambulance services are separately reimbursable only under Part B. Once a beneficiary is admitted to a hospital, CAH, or SNF, it may be necessary to transport the beneficiary to another hospital or other site temporarily for specialized care while the beneficiary maintains inpatient status with the original provider. This movement of the patient is considered “patient transportation” and is covered as an inpatient hospital or CAH service and as a SNF service when the SNF is furnishing it as a covered SNF service and payment is made under Part A for that service.

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