Covered Destinations for Ambulance Transportation

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Covered Destinations for Ambulance Transportation
Basics of Destinations for Ambulance
Transportation Ambulance transport is covered to
the nearest appropriate facility to obtain
necessary diagnostic and/or therapeutic services
such as a CT scan or cobalt therapy as well as
the return transport. In addition to all other
coverage requirements, this transport situation
is covered only to the extent of the payment that
would be made for bringing the service to the
patient. Most of the insurance carriers cover
ambulance transports to destinations like
hospitals Critical Access Hospital (CAH)
Skilled Nursing Facility (SNF) from an SNF to
the nearest supplier of medically necessary
services not available at the SNF beneficiarys
home dialysis facility for ESRD patient who
requires dialysis.
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Covered Destinations for Ambulance Transportation
In this article, we will be understanding such
covered destinations for ambulance
transportation. As a general rule, only local
transportation by ambulance is covered, and
therefore, only mileage to the nearest
appropriate facility equipped to treat the
patient is covered. However, if two or more
facilities that meet the destination requirements
can treat the patient appropriately and the
locality of each facility encompasses the place
where the ambulance transportation of the patient
began, then the full mileage to any one of the
facilities to which the beneficiary is taken is
covered. Covered Destinations for Ambulance
Transportation Institution to Beneficiarys
Home Ambulance service from an institution to
the beneficiarys home is covered when the home
is within the locality of such institution or
where the beneficiarys home is outside of the
locality of such institution but the institution,
in relation to the home, is the nearest one with
appropriate facilities. Institution to
Institution
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Covered Destinations for Ambulance Transportation
Occasionally, the institution to which the
patient is initially taken is found to have
inadequate or unavailable facilities to provide
the required care, and the patient is then
transported to a second institution having
appropriate facilities. In such cases,
transportation by ambulance to both institutions
would be covered to the extent of the mileage to
be the nearest institution with appropriate
facilities. In these cases, transportation from
such a second institution to the patients home
could be covered if the home is within the
locality served by that institution, or the
locality served by the first institution to which
the patient was taken. Not Inpatients Ambulance
transports to and from a covered destination
(i.e., two 1-way trips) furnished to a
beneficiary who is not an inpatient of a provider
for the purpose of obtaining covered medical
services are covered, if all program requirements
for coverage are met. In addition, coverage of
ambulance transports to and from a destination
under these circumstances is limited to those
cases where the transportation of the patient is
less costly than bringing the service to the
patient.
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Covered Destinations for Ambulance Transportation
Appropriate Facilities The term appropriate
facilities means that the institution is
generally equipped to provide the needed hospital
or skilled nursing care for the illness or injury
involved. In the case of a hospital, it also
means that a physician or a physician specialist
is available to provide the necessary care
required to treat the patients
condition. However, the fact that a particular
physician does or does not have staff privileges
in a hospital is not a consideration in
determining whether the hospital has appropriate
facilities. Thus, ambulance service to a more
distant hospital solely to avail a patient of the
service of a specific physician or physician
specialist does not make the hospital in which
the physician has staff privileges the nearest
hospital with appropriate facilities. Special
Case Medicare Coverage Transportation of a
beneficiary from his or her home, an accident
scene, or any other point of origin is covered
under Medicare part B as an ambulance service
only to the nearest hospital, critical access
hospital (CAH), or skilled nursing facility
(SNF) that is capable of furnishing the required
level and type of care for the
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Covered Destinations for Ambulance Transportation
beneficiarys illness or injury and only if
medical necessity and other program coverage
criteria are met. Ambulance transport from an
SNF to the nearest supplier of medically
necessary services not available at the SNF where
the beneficiary is a resident and not in a
covered Part A stay, including the return trip,
is covered under Part B provided that the
ambulance transportation was medically reasonable
and necessary and all other coverage requirements
are met. Medicare-covered ambulance services are
paid either as separately billed services, in
which case the entity furnishing the ambulance
service bills Part B of the program or as a
packaged service, in which case the entity
furnishing the ambulance service must seek
payment from the provider who is responsible for
the beneficiarys care. If either the origin or
the destination of the ambulance transport is the
beneficiarys home, then the ambulance transport
is paid separately by Medicare Part B, and the
entity that furnishes the ambulance transport may
bill its A/B MAC (A) or (B) directly. Medical
Billers and Coders (MBC) is a leading medical
billing company providing complete medical
billing and coding services. We
referred Medicare Benefit Policy Manual Chapter
10 to discuss covered destinations for ambulance
transportation.
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Covered Destinations for Ambulance Transportation
For any assistance in ambulance transportation
billing, email us at info_at_medicalbillersandcoders
.com or call us at 888-357-3226. FAQs 1 What
types of destinations are covered for ambulance
transportation? Covered destinations include
hospitals, Critical Access Hospitals (CAHs),
Skilled Nursing Facilities (SNFs), and dialysis
facilities, as long as they provide necessary
medical services. 2 Is ambulance transportation
from a facility to a patients home
covered? Yes, ambulance services from an
institution to the beneficiarys home are covered
if the home is within the locality of the
institution or is the nearest appropriate
facility. 3 Can a patient be transported from
one institution to another? Yes, if the first
institution cannot provide the necessary care,
ambulance transport to a second institution with
appropriate facilities is covered.
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Covered Destinations for Ambulance Transportation
4 What does appropriate facilities mean in the
context of ambulance transportation? Appropriate
facilities refer to institutions equipped to
provide the necessary hospital or skilled nursing
care for the patients condition. 5 How does
Medicare cover ambulance transportation
services? Medicare covers ambulance transport as
a separate billed service or as a packaged
service, depending on the origin and destination
of the transport, ensuring medical necessity
criteria are met.