The fact that the definition has been adopted was not intended to suggest that bed confinement is the sole determinant of medical necessity. It is the responsibility of ambulance suppliers to furnish complete and accurate documentation to demonstrate that the ambulance services being furnished meet the medical necessity criteria. Our purpose was to develop an ambulance specific definition that would identify, as eligible for covered services, only those individuals who are not able to be up and out of bed under any condition and therefore unable to tolerate being transported by other methods of transportation. Specifically, the physician is responsible for supervising the medical care of the patient including reviewing the patient's program of care, ordering medications and monitoring changes in the patient's medical status, and signing and dating all orders. Yes, that is correct.
Carriers are responsible for considering all submitted documentation when processing claims.
No, the 60-day physician certification is not all inclusive. At the time that the certification is ordered, it is ordered on the basis that a specific condition exists that warrants the need for ambulance transportation service. Any and all documentation submitted should reflect the patient's condition at the time the ambulance service is furnished thereby supporting the need for the ambulance service. It is important to note that at this time, HCFA has not made the necessary modifications to the claims forms that will allow ambulance suppliers to indicate that the physician certifications are on file. Absent the ability to provide such notification, ambulance suppliers are still required to obtain the certification, retain the certification on file and, upon request from the carrier, present the requested certification documentation.