The form must be signed by the physician ordering the ambulance. A facsimile copy will be accepted. The table on pages five and six describe when the medical necessity form is required. The Medicare program closely watches for fraud and abuse. False diagnoses and faulty documentation, such as declaring a patient bed confined when they are not bed confined, are serious offenses.
Abuse is defined as excessive or inappropriate health care services.
A high percentage of claims which are not medically necessary constitute abuse. Postpayment Utilization Review studies claims and documentation looking for fraud and abuse. Special Regulations Applying to Medicaid Medicaid is a program of medical assistance for needy low-income individuals and families. The Rowan County Department of Social Services determines eligibility for the program. DSS also explains the benefits to participants.