Ambulance Services

Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for ambulance services:

• • Missing documentation to support the beneficiary could not safely be transported by any other means.
  • Missing AOB form
  • Missing provider certification of medical necessity for non-emergency, scheduled, repetitive ambulance services
  • Missing electronic signature or legible signature of the ambulance crew

Missing documentation to support medical necessity: A run report that supports the ambulance transport is medically necessary and the patient’s health would be endangered if traveled by other means.

Assignment of Benefits form: Medicare requires the signature of the beneficiary, or that of his or her representative, for both the purpose of accepting assignment and submitting a claim to Medicare.

Certification for ambulance: Medicare covers medically necessary nonemergency, scheduled, repetitive ambulance services if a written order is obtained from the beneficiary's attending physician certifying that the medical necessity requirements are met. The physician's order must be dated no earlier than 60 days before the date the service is furnished.

Signature: An electronic signature or legible signature is required on run reports.

Related Content

• • CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.2.2 – Reasonableness of Ambulance Trip) Section 20.1.2 (Beneficiary Signature Requirements)
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4 (Signature Requirements)
  • MLN Booklet: Medicare Ambulance Transports
  • Special Rule for Non-Emergency, Scheduled, Repetitive Ambulance Services - 42 CFR 410.40(d)(2)