Physician Compliance: Ambulance Prior Authorization Documentation

Physicians and practitioners ordering ambulance transports are asked to remember the three year prior authorization model for repetitive scheduled non-emergent ambulance transports began December 1, 2014 in South Carolina and on January 1, 2016 for Virginia, West Virginia and North Carolina.

As the ordering physician/practitioner, you are required to supply the ambulance supplier or beneficiary the physician certification statement as well as any other documentation that supports medical necessity for the repetitive scheduled non-emergent ambulance transports. The requirement to submit this needed documentation is part of provider compliance in the Medicare program. Keep in mind that the prior authorization model does not create new documentation requirements for physicians/practitioners or suppliers – it simply requires the documentation to be submitted earlier in the claims process.