Ambulance Prior Authorization Reminders

Ambulance providers should understand the requirements for transporting Medicare patients. Stay in the know with these helpful reminders.

A Physician Certification Statement (PCS) is required and must have an appropriate date as required for each prior authorization request period.

• The PCS is valid for 60 days. The ambulance supplier should submit the PCS that is valid for the start date provided on the PA request. A valid PCS should be maintained throughout the approval period even if the PCS expires prior to the end of the 60-day PA period.

The PCS is not considered a medical record to support medical necessity for purposes of the prior authorization process, and alone does not support the medical necessity for a patient to be transported by stretcher.

Medical records to support medical necessity are generated by a medical professional certified by the state on — or during — a patient encounter, and may include doctor’s progress notes, nurse’s notes, therapy notes, history and physical examination notes authenticated by the performing provider.

Submitting only a provider letter, prescription, provider (doctor’s) order or attestation statement in support of the need for ambulance transport in addition to the PCS does not establish medical necessity nor does it meet medical necessity documentation requirements.

• In some cases, an attestation statement in addition to relevant signed/authenticated medical records may help paint the picture of the patient’s condition(s) that necessitate stretcher only transport
• An attestation is a written statement that supplies witness, testimony or evidence to a patient’s condition and is made separate from a medical record created as the result of a patient/provider encounter