Ambulance Prior Authorization

Medicare Prior Authorization Program

Repetitive Ambulance Patients

Minimize cash flow and patient care disruptions

Providers can benefit greatly from partnering with the right expertise and support.  Medicare’s latest effort to reduce non-emergency ambulance expenses is causing chaos for some providers.  If you are in one of the affected states, you are no doubt feeling the pressure of this difficult process.  Unfortunately, there are no quick and easy workarounds, this issue has to be addressed head on and with determination.  Whether you are transporting patients in a state that is already affected, or you are in one of the other states scheduled for roll out on January 1, 2017, the time to act is now.  We have seen some provider go without payment for as long as three months while they navigated the documentation and clerical requirements of a prior authorization.  The CMS training guidelines are helpful, but the carriers have to interpret them for your region.  Don’t forget, the carriers have a very different mission than you have.  They are not truly responsible for the quality of EMS or ambulance care in your community, they are charged with a duty to reduce expenditures on non-emergency ambulance transports.  The OIG has studied the results of ambulance audits for years, concluding that 75% of all non-emergency ambulance patients are not medically necessary.  Medicare carriers have their marching orders, they are going to deny a high percentage of prior authorization requests, this is all but guaranteed by the current regulatory landscape.  By being prepared for this change, you can minimize cash flow downtime and ensure patients get the care they need, but you have to act fast.


Call PMC today for assistance with your repetitive patients!!!  1-800-635-7577