Ambulance Provider Regulations For Medicare

Ambulance services may be covered by Medicare.

Ambulance services may be covered under Medicare Part A, hospital, skilled nursing facilities and other inpatient facilities or under Part B. When covered by Part A, the facility requesting the transportation is responsible for payment to the ambulance provider. Ambulance services are payable separately, however, only under Medicare Part B and must adhere to the regulations set forth in the Medicare Benefit Policy Manual, Chapter 10, Ambulance Services.

Vehicle Requirements

Only the ambulance provider that actually furnishes the transportation may be entitled to payment, and because this benefit is a transport benefit, without actual transportation, no payment may be allotted. Vehicles must be designed to respond to emergencies and contain life-saving emergency medical equipment, as well as emergency lights, sirens and communications as dictated by state or local law.

Basic Life Versus Advanced Life Ambulance Providers

Basic life and advanced life ambulance providers must adhere to not only the requirements listed above, but also staffing requirements. Basic life providers must have at least two crew members, of which one is a licensed Emergency Medical Technician (EMT) in the state and locality where the ambulance provides service. Advanced life providers must have at least two crew members of which one is an EMT-Intermediate or EMT-Paramedic licensed in the state and locality where the ambulance provides service.

Necessity

Medicare defines necessity of transportation by ambulance as one that is contraindicated by any other method of transportation. If another means of transportation could have been used without endangering the patient, Medicare will not pay for ambulance services even if no other means of transportation was available at the time. Documentation must be kept on all patients and submitted upon request to the Medicare carrier. Physician’s request or prescription for ambulance transportation does not necessarily guarantee payment by Medicare and prove medical necessity. Finally, bed confinement prior to and after transport is viewed as a medically necessary transport and payable by Medicare.

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