Ambulance Transports are a necessity in life. They save hundreds of lives every day. However, some ambulance companies are in hot water for improper payments as well as questionable billing, which generally involves transport to non-covered destinations and unusually high average mileage on these transports.
HHSC-OIG conducted a study regarding the aforesaid problems and found that Medicare paid $24 million in the first half of 2012 for ambulance transports that did not meet certain program requirements to justify payment. Medicare also paid $30 million for transports for which the beneficiaries did not receive Medicare services at the pick-up or drop-off locations, or anywhere else. In addition, about one in five suppliers had questionable billing, which is commonly geographically concentrated in metropolitans, like Houston, Philadelphia, New York, and Los Angeles.
In order to combat ambulance transport fraud and abuse, OIG the made below recommendations which has been concurred by CMS:
(1) Determine whether a temporary moratorium on ambulance supplier enrollment in additional geographic areas is warranted;
(2) Require ambulance suppliers to include the National Provider Identifier of the certifying physician on transport claims that require certification;
(3) Educate physicians who certify dialysis-related ambulance transports on Medicare's coverage requirements;
(4) Implement new claims processing edits or improve existing edits to prevent inappropriate payments for ambulance transports;
(5) Increase its monitoring of ambulance billing, and
(6) Determine the appropriateness of claims billed by ambulance suppliers identified in the report and take appropriate action.
With increasingly stringent inspection and monitoring, more and more ambulance companies are facing or will face these problems. In order to avoid been investigated by OIG, it is important to make sure all actions and billing claim submissions meet the requirements of CMS.