August 7, 2014 | Comments Off on Medicare Joins New Jersey Medicaid In Mandating Pre-Authorization for Non-Emergency Ambulance Transports
Posted by Beth Christian
CMS has announced that it will be transitioning to us of a prior authorization requirement for repetitive non-emergency ambulance transports. New Jersey Medicaid already has a pre-authorization requirement. Under the prior authorization requirement, ambulance suppliers will need submit a request for provisional affirmation of coverage before a non-emergency, repetitive ambulance transport is rendered to a Medicare beneficiary and before a claim for payment may be submitted. A repetitive ambulance service is defined as medically necessary ambulance transport services that are furnished 3 or more times in a 10 day period or at least 1 per week for 3 weeks. Repetitive services typically arise for patients who receive dialysis, wound care or cancer treatment. New Jersey is one of 3 states where the pre-authorization program will be initially implemented.