updated: 5/26/17
In December 2014, new Medicare rules on ambulance transportation went into effect here in New Jersey.
CMS implemented the new rules to weed out fraud from ambulance companies billing Medicare for transportation on a stretcher in an ambulance when other, less costly methods would have sufficed. While many welcomed these changes, there have been some unintended consequences.
As a result, it can now be quite difficult to get Prior Authorization for ambulance transportation in New Jersey through Medicare. However, following some best practices can greatly improve your chances to get approval.
1. Use an ambulance company with an in-house authorization nurse
Having a dedicated authorization employee on staff can be critical. This person’s sole job is obtaining these authorizations for his or her patients. An extra experienced professional in your corner can make the difference between approval and denial.
2. Make sure the doctor's notes are legible
This can be a tall order. Doctors have notoriously bad handwriting. But this can really have a huge impact. A doctor can meticulously describe the reasons why a patient needs an ambulance and a full stretcher for transportation, but it won’t matter if the person determining the level of care can't read them.
3. Include a full mobility assessment in the patient's record
“Non-ambulatory” isn't enough. With a more descriptive mobility assessment, the patient’s chances of approval greatly increase.
4. Remember to not leave any portion of the EMR on the default setting
Leaving fields unchecked is a red flag. Medicare wants as complete an assessment as possible. If they notice that some fields are not checked, they will be more likely to further scrutinize the entire record.
Following these guidelines will of course not guarantee prior authorization approval. But from our experience, it will certainly increase the likelihood.
Want to learn more about the prior authorization process for ambulance transport? Visit the link below.
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Prior Authorization for Ambulance Transport: What You Need to Know