Legion Healthcare Solutions

Ambulance Transportation Billing Services

Ambulance Transportation Billing Services

Ambulance transportation is regarded as a convoluted procedural billing with a focus on patient care, led by modifiers and prior authorization for ambulance service. Legion Healthcare Services (LHS) understands how imperative is the coding procedure when denials are high; hence to supplement the billing process for ambulance transportation we follow the non-conventional way of billing by sending the claim twice to our LHS certified coders before submitting it to Medicare.
Medicare Part B covers the ground ambulance transportation for the case when the patient needs to be transported to a hospital or skilled nursing facility for medically necessary services. LHS understands the demands of a claim for ambulance billing, so it would need to establish that all other transportation could have endangered the health of the patient. In emergency cases, Medicare can pay for air medical transport but the patient needs to have a life-threatening situation and the ground ambulance service should have failed.
“Ambulance Transportation billing is unique even for certified coders, not all claims are paid. Emergency and non-emergency services are defined into several categories and even after that patient has to pay a part of the payment. The claims are reviewed twice before submission.”

– Certified Coder for Ambulance Billing at LHS

Medicare will cover the scheduled/ regular non-emergency ambulance transportation if the ambulance provider receives a written order from you stating that the transport is necessary. LHS will process this order to an ambulance service provider with a time period of less than 60 days in hand.

LHS even recommends that for non-emergency or irregular visits that require ambulance transportation a written order should be submitted within a time period of 48-hours after the visit

To reduce your chances of denial, LHS has even prepared a list of states where prior authorization is required before taking an ambulance service: Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, South Carolina, Virginia, West Virginia, and North Carolina.

Ambulance services providers can submit the claim using CMS-1500 and for hospital-based ambulance service UB-04 is used, by specifying the NPI assigned for an ambulance.

To make the claims denial free, Legion team recommends a specific base rate for each routine supply and equipment. Medicare specifies that ambulance billing should be based on the level of service and not the type of vehicle.

In certain cases, ambulance staff might be equipped to deal with patients wherein the code A0998 will be used. LHS is required to add the number of mileage codes for each patient's ambulance transportation.

LHS has a complete list of criteria for ambulance billing: Credentials of attendant/ EMT’s, trip sheet, origin, and destination needs to be noted.

For prior authorization and co-payment a dedicated team built by Legion for ambulance billing.

Complete verification of patients' origin and destination to understand whether it will be co-payment or complete patient pay.

A certified team of coders works specifically for ambulance billing to improve the AR.

To reduce the claim denials a regular follow-up is done with payers.

API-and RPM-based technology to improve the patient experience.

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