Advanced Life Support Ambulance Services: Insufficient Documentation

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 5th, 2016

Ambulance suppliers often submit Medicare claims for Advanced Life Support (ALS) ambulance services which lack sufficient medical record documentation. The 2015 Comprehensive Error Rate Testing (CERT) Report states that the improper payment rate for ALS services was 14.5 percent with improper payments projected at $226 million. The most frequent errors occur when documentation:

• Does not support the medical necessity of the ALS level of service
• Lacks the patient’s signature authorizing the supplier to bill Medicare for the service.

Use the following resources to avoid documentation errors:

• Medicare Ambulance Transports Booklet
• 42 Code of Federal Regulations 424.36 - Signature Requirements
• April 2016 Medicare Quarterly Provider Compliance Newsletter, Pages 1 through 3
• Ambulance Fee Schedule Fact Sheet
• Medicare Claims Processing Manual, Chapter 15

References:

• CMS.gov