Jurisdiction M Part B Prior Authorization Extended Affirmation Teleconference Questions and Answers: August 14, 2019

Question: When were extended affirmations first available for ambulance prior authorization?

Answer: Effective June 3, 2019, the MACs can allow up to 240 one-way trips in a 180-day period prior authorization request for beneficiaries with chronic conditions that are deemed not likely to change over time. Those transports must also meet Medicare requirements for repetitive non-emergent transport.

Question: How do I request an extended affirmation period for my ambulance prior authorization patient?

Answer: The decision to allow an extended affirmation period is at the discretion of the Medicare Administrative Contractor (MAC). Ambulance suppliers cannot request transports beyond the current maximum of 80 transports per 60-day period. Requests for 240 transports will be returned as we cannot proceed with reviewing for that number. These are not appropriate and may slow processing times for valid requests.

Question: What are the requirements for an extended affirmation period?

Answer:

  • The medical records must clearly indicate the condition is chronic
  • Two previous Concurrent (meaning there were two previous affirmations prior to the next request being considered for the extended period) prior authorizations must have established that the beneficiary’s medical condition has not changed or has deteriorated
  • Suppliers are responsible for maintaining a valid physician certification statement (see PCS Land Ambulance: Physician Certification Statement (PCS) Requirements) at all times
  • The ambulance supplier must keep appropriate documentation and present it upon request
  • Each individual time that a patient is transported by ambulance that transport must be reasonable and necessary, regardless of whether a new prior authorization is required

Question: Where can I find more information about ambulance prior authorization?

Answer: These links provide more detail about ambulance prior authorization.

Question: Are extended affirmation periods changing the documentation requirements?

Answer: No, documentation requirements aren't changing.

Question: How will I know if an extended affirmation period has been granted for a particular patient?

Answer: The letter that you receive with the Unique Tracking Number (UTN) indicates if an extended affirmation period has been granted. It will show 240 extended transports with the new expiration date instead of the usual 80 transports.

Question: My patient was approved for 240 trips and has passed the initial 60-day period. He needs a new Physician Certification Statement (PCS), but he ended up using a different physician. Are we responsible for making sure we get the new PCS signed and the correct date and making sure we have a signature logged for the new nephrologist?

Answer: Yes, and keep that information on file. Whether the affirmation is for the 80 transports or the extended transports at 240, it is the ambulance supplier’s responsibility to keep a current PCS on file.

Question: Will we continue to get a repetitive Physician Certification Statement (PCS) to keep on file every 60 days even if we were approved for the extended period?

Answer: A PCS is only valid for 60 days, so regardless of whether you are approved for 60 days or 180 days a PCS must be present for every 60 days. An extended affirmation period does not change the PCS requirements.

Question: Will an affirmed Unique Tracking Number (UTN) for an extended affirmation period transfer to another provider? The provider we originally got an affirmation with is not the same one the patient ended up using.

Answer: The UTN is specific to the ambulance supplier so if the beneficiary changes ambulance suppliers, the new ambulance supplier would submit for that transport period and obtain a new UTN.

Question: If a patient is affirmed for repetitive trips with another ambulance supplier before coming to us, is a UTN required before the fourth round trip with us?

Answer: If the beneficiary previously met criteria for repetitive transports, then additional transports without a UTN are not permitted with a transfer in care. After the initial affirmed 60-day period of transport, repetitive transport has been determined and a UTN is required for all further repetitive transport. In addition, each provider must obtain an approved UTN for a beneficiary’s ambulance transport, despite transfer of care.

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