In a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number of key problems, including:
- Ambulance transports for beneficiaries who did not receive any Medicare services at the point of origin or destination
- Transports to noncovered destinations
- Excessive mileage reported on claims for urban transports
- Medically unnecessary transports to partial hospitalization programs
- Inappropriate transport service levels
Review the following resources to bill correctly for this service:
- OIG Report: Inappropriate Payments and Questionable Billing for Medicare Part B Ambulance Transports
- Medicare Benefit Policy Manual: Chapter 10 – Ambulance Service
- Medicare Benefit Policy Manual: Chapter 15 – Ambulance
- 42 CFR 410.40: Coverage of Ambulance Services
- 42 CFR 410.41: Requirements for Ambulance Suppliers
- 42 CFR 410.41: Definitions
- 42 CFR 414.610: Basis of Payment
- Ambulance Fee Schedule website
- Ambulance Fee Schedule Fact Sheet
- Medicare Ambulance Transports Booklet
- CMS Transmittal 9620
