CMS expands model requiring prior authorization for non-emergent ambulance trips

The Centers for Medicare & Medicaid Services has announced via the Federal Register that it is expanding the three-year Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport to include Maryland, Delaware, the District of Columbia, North Carolina, West Virginia, and Virginia. The expansion will begin Jan. 1, 2016.

The model requires a written order from the beneficiary's attending physician certifying that the medical necessity requirements are met prior to providing scheduled, non-emergent transportation by ambulance to services such as dialysis and cancer treatments.

The model began first in in three states, New Jersey, Pennsylvania, and South Carolina, on Dec. 1, 2014. These states were selected as the initial states for the model because of their high utilization and improper payment rates for these services, CMS said. The model will end in all three states on Dec. 1, 2017.

According to CMS, the use of prior authorization does not create new clinical documentation requirements, but requires the same information that is already required to support Medicare payment, just earlier in the process.

Read more about the model and its expansion in the Federal Register. -by Rebecca Zumoff