CMS to extend prior authorization for ambulance transport: 4 things to know

Four things to understand:.

CMS is broadening a payment model for nonemergent ambulance flights after it conserved $650 million over 4 years and didnt disrupt access for beneficiaries.

Morgan Haefner –
Wednesday, September 23rd, 2020

1. The Medicare prior authorization design for recurring, scheduled nonemergent ambulance transport, or RSNAT, evaluates if prior permission saves Medicare money while enhancing quality for recurring ambulance services..

2. Arranged, recurring ambulance services are frequently utilized by Medicare beneficiaries who require an ambulance ride to medical visits. These kinds of ambulance transportations are normally amongst the leading Medicare Part B services with inappropriate payments..

3. Based upon preliminary results, the previous permission design, which started in numerous East Coast states, will be expanded nationally. Assessments of its first 4 years found that the model reduced repetitive, scheduled nonemergent ambulance rides by 63 percent and lowered expenses for the flights by 72 percent for patients with kidney failure or severe pressure ulcers.

4. Stating the design “a resounding success” that recipients throughout the country deserve to gain from, CMS Administrator Seema Verma said: “When released properly, previous authorization can assist guarantee Medicare requirements are satisfied before a service is supplied and the claim is paid, without producing any new documents requirements for companies.”.

Set up, repeated ambulance services are typically used by Medicare beneficiaries who need an ambulance flight to medical consultations. Based on initial results, the prior permission model, which began in several East Coast states, will be broadened nationally. Assessments of its first four years discovered that the design lowered repetitive, scheduled nonemergent ambulance flights by 63 percent and decreased expenses for the rides by 72 percent for patients with kidney failure or serious pressure ulcers.

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