• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer
California Health Advocates

California Health Advocates

  • Contact
  • Home
  • About Us
    • Contact
    • Our Team
    • Mission
    • Education Services
    • About HICAP
    • Press
    • Testimonials
  • MEDICARE COUNSELING
  • Fact Sheets
  • Topics
    • The Basics
    • Prescription Drugs
    • Low-Income Help
    • Medigap
    • Medicare Advantage
    • Other Health Insurance
    • Appeals
    • Billing & Claims
    • Disabilities
    • Long-Term Care
    • Tribal Nations & Medicare
    • Health Care Reform
    • Advocacy & Policy
    • Glossary
  • Fraud & Abuse
  • Medicare Complaints
  • Blog
  • Donate

New Agreement Between AMR & Advocates Gives Beneficiaries More Time to Resolve Ambulance Appeals

California Health Advocates > News > Medicare Billings, Claims & Appeals > New Agreement Between AMR & Advocates Gives Beneficiaries More Time to Resolve Ambulance Appeals

Posted by Karen Joy Fletcher on May 7, 2012

With ambulance rides being one of the most expensive modes of transport, Medicare has strict medical necessity guidelines to prevent overuse of this benefit. If Medicare has reason to doubt medical necessity in a beneficiary’s ambulance transport, Medicare will often deny payment of the claim. While these strict guidelines are understandable, advocates across the state have seen a rise in denied payment of beneficiaries’ ambulance services, even when medical necessity is seemingly a given.

One problem we’ve seen is that often the billing codes submitted by the ambulance transport company determines whether a beneficiary’s transport meets the medical necessity requirements. If the ambulance company doesn’t submit the proper codes that denote medical necessity, Medicare will often automatically deny a claim and then it is up to the beneficiary to file an appeal. Also, American Medical Response (AMR), one of the primary ambulance transport service providers in California, has had a policy that if Medicare denies an ambulance service, the beneficiary must pay the bill, or set up a payment plan within 30 days; otherwise, their bill goes to a collection agency. This 30-day policy is hardly enough time, especially if a beneficiary has been in the hospital and/or rehab, for s/he to find out about Medicare’s denied payment and file an appeal.

To remedy this situation, two Medicare advocates in Santa Cruz County, Health Insurance Counseling and Advocacy Program (HICAP) Program Manager, Debbie Reed, and Senior Medicare Patrol (SMP) Liaison, Evelyn Taylor set up a meeting with AMR and also arranged for them to speak at our recent biannual Medicare training conference in Pasadena, California. The meetings were a success and as a result, HICAP Program Managers and their volunteer counselors have a specific contact at AMR to call regarding ambulance billing questions. Also, if a HICAP/SMP advocate calls and states they are working with a beneficiary to appeal/resolve their ambulance trip directly with Medicare, AMR’s billing service, Patient Business Services (PBS) will automatically put the beneficiary’s account on hold for 90 days; this is two times as long as the previously noted 30-day policy. This will prevent the beneficiary’s claim from going to a collection agency while an appeal is filed and awaiting Medicare’s redetermination on the claim.

This is a great step forward in advocate and provider collaboration and a great win for beneficiaries. An article on a beneficiary whose successful ambulance appeal relates directly to this new agreement will be posted soon.

See Medicare’s Coverage of Ambulance Services (PDF), for more information on Medicare’s coverage of ambulance services.

 

Filed Under: Medicare Basics, Medicare Billings, Claims & Appeals Tagged With: ambulance services, Medicare

Previous Post: « CMS Announces New Administration on Community Living
Next Post: Join Our SMP Director at National Summit on Elder Financial Abuse »

About Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA's Communications Director. With a Masters in Public Health from UC Berkeley, she is the online "public face" of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a "communicator" and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.

Related Posts

  • Medicare Covers COVID-19 Tests & CMS Issues Guidance to Medicare Advantage & Part D Plans
  • More Good News Regarding Equitable Relief for Part B Penalties
  • New Class of Hospital Patients May Gain Access to Appeal “Observation Status”
  • Review Medicare’s Coverage of Durable Medical Equipment & How to Use this Benefit

Primary Sidebar

Change Text Size

  • 100%  110%  120%  130%  

News & Blog Categories

  • Medicare Advantage
  • Low-Income help
  • Medicare & Disabilities
  • Medicare Basics
  • Prescription Drugs
  • Medicare & Other Health Insurance
  • Medicare Billings, Claims & Appeals
  • Health Care Disparities
  • Fraud & Abuse

—

  • COVID-19
  • Resources
  • Health Care Reform
  • Long-Term Care
  • CHA News

—

  • Advocacy & Policy
  • Letters and Comments to Policymakers
  • Legislative and Congressional Testimony
  • Policy Briefs

Send Us Comment

Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at comments@cahealthadvocates.org.

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

Archives

Donate Today

Footer

Sign up for our newsletter

Choose the news you'd like to receive

Important Links

  • About Us
  • Fact Sheets
  • Blog
  • Donate
  • Contact
  • Privacy Notice
  • Cookie Policy
  • Accessibility Statement

Follow Us

Copyright © 2023 · California Health Advocates · Web Design by TWK Web and Print Design · Log in