Because the Medicare rules governing ambulance services are complex and unique, providers should implement an effective audit program to assure they meet the applicable requirements. This article identifies the most important issues to be addressed in an ambulance service audit and summarizes the applicable rules. The issues that should be addressed include determining whether: services are medically necessary and billed at the correct level of service; a physician certification statement is properly procured, when necessary; only covered mileage is billed for; the requirement for a beneficiary signature is met; and a health facility or hospice, rather than Medicare, has been billed when required under Medicare rules. Providers should also assure their crews and vehicles meet applicable coverage requirements; their Enrollment Applications (Form 855) are up to date; and their financial relationships with referral sources comply with the Anti-kickback Statute.
Read the complete article by clicking on the link below.
Reprinted with permission from New Perspectives on Healthcare Risk Management, Control and Governance, Journal of the Association of Healthcare Internal Auditors, Inc. Winter, 2008, Volume 27, Number 1.