Frequently Asked Questions

As of July 1, 2007 billing services are provided by EMS Consultants. They may be contacted at 800-814-5339.

HCEMS does bill for services. The billing office will bill Medicare, Medicaid and third-party insurance companies.

The following list some of the more common situations which suggest transportation by ambulance may be medically indicated:

• The patient was transported in an emergency situation (e.g. as a result of an accident, injury or acute illness)
• Emergency measures or treatment were required (e.g. drugs, CPR, cardiac monitor, etc.)
• The patient needed to be restrained to prevent injury to himself or others (e.g, patient was combative, patient was convulsive, etc.)
• The patient was unconscious (was unable to respond to external stimuli), this does not include patients who are comatose or in a vegetative state, with no specific reason for the transport;
• The patient was in shock
• The patient required IV fluids to maintain adequate blood pressure (e.g, dehydration, bleeding, cardiac arrhythmias, etc.) or an access line to administer medication(s)
• The patient required oxygen in route to his destination. However, this is not a covered condition if oxygen equipment has been prescribed as part of therapy or a treatment regimen and that equipment was available to the patient
• The patient required immobilization to prevent further injury of a fracture or possible fracture
• The patient sustained an acute stroke or myocardial infarction (this does not include patients who have a history of a stroke or myocardial infarction and are able to be transported by other means because no acute medical condition exists)
• The patient was experiencing symptoms indicative of a possible myocardial infarction or stroke
• The patient was experiencing a severe hemorrhage
• The patient was bed confined before and after the ambulance trip (bed confined due to old age does not qualify). Document the patient's condition in your files to include the reason why the patient was bed confined
• The patient could be moved only by stretcher and any other method of transportation would result in injury or would be detrimental to the patient's health

This is not an all inclusive list of covered conditions. If the patient is transported for any non-emergency condition, the medical need for the services must be clearly documented.

• To or from the doctor's office or a physician-directed clinic. (Exception: If in the course of transporting a patient to a hospital, the ambulance stops at a physician's office because of the patient's dire need for professional attention and immediately thereafter the ambulance takes the patient to the hospital, payment can be made for the entire trip)
• Transfer from one residence to another. (A nursing home is considered to be a place of residence)
• Transfer from a hospital which has appropriate facilities for treatment to another hospital
• Transportation of a deceased patient to a funeral home
• Transportation to a non approved dialysis facility for routine maintenance dialysis
• Waiting time charges - the charge an ambulance company makes for time spent while waiting for the patient
• The patient refuses to be transported. If, after responding to a call from a patient, no transportation service is rendered, the supplier should not bill Medicare for the unloaded mileage to the patient's location and the ambulance crew's assessment of the patient as an ambulance transportation service, since no ambulance service is rendered
• Oral or self administered drugs
• Assessing the patient's condition or taking vital signs
• Charges made for services not rendered, or bills submitted for the express purpose of obtaining payment from Medicare for know non-covered services constitutes fraudulent billing practices. Claims submitted for denial purposes used for billing a supplemental insurer would not be considered fraudulent billing

In most cases, ambulance services are not covered if:

• The patient is ambulatory
• The patient is not admitted as a hospital inpatient (except in accident and emergency cases)
• A routine trip to return the patient to his or her home is generally not covered
• The patient is transported from home or a nursing home to the hospital outpatient department, and returned, for treatment that could have been performed elsewhere (e.g, patient's home or doctor's office)