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CMS wants prior authorization for non-emergency ambulances nationwide

29 Oct 2019 8:31 AM | AIMHI Admin (Administrator)

Modern Healthcare source article | Comments courtesy of Matt Zavadsky

CMS wants prior authorization for non-emergency ambulances nationwide

MICHAEL BRADY 

The CMS wants to expand prior authorization for non-emergency ambulance transportation nationwide and on Friday requested ambulance services for information that could help achieve that goal.

The agency has been testing prior authorization for repetitive, scheduled, non-emergency ambulance transportation for its Medicare beneficiaries in several states since 2014.

In a notice, the CMS said it will collect information from ambulance providers on how many and what type of transportation services are necessary. Prior authorization would require providers to hand over all medical records associated with ambulance services.

The agency would freeze payments for review and approval if the ambulance supplier doesn't submit a prior authorization request after four round trips during a 30-day period.

The CMS has been testing whether prior authorization cuts healthcare spending by curbing Medicare-covered ambulance transportation. The program's early results show substantial declines in utilization and spending during the first year of implementation.

The agency announced in September that it's extending the trial for another year in Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia.


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