Documentation & Patient Care Reporting, News

Feds Want Prior Authorization for All Non-Emergency Transports

Above photo, National Highway Traffic Safety Administration

The Centers for Medicare and Medicaid Services (CMS) is looking to expand prior authorization for non-emergency medical transportation in ambulances to a nationwide model.

The agency requested information from ambulance services last week for Repetitive Scheduled Non-Emergent Ambulance Transports.

Related: Does Your Current Billing Service Set Your EMS Organization Up for Success?

CMS “believes using a prior authorization process will help make sure services are provided in compliance with applicable Medicare coverage, coding and payment rules before services are rendered to the beneficiaries and before claims are submitted for payment,” according to a notice.

CMS said the change would not require new documentation standards. Instead, the agency will require reimbursement paperwork to be submitted earlier in the process.

Related: The EMS Reimbursement Revolution – Experts Provide Tips for Success

The agency has been testing this model since 2015 in Pennsylvania, New Jersey and South Carolina. In 2016, the testing expanded to Delaware, the District of Columbia, Maryland, North Carolina, Virginia and West Virginia.

In those states, the agency said spending went down by millions of dollars.