Six things to know about prior authorization for ambulances

CMS on Thursday announced the start dates for the agency’s nationwide expansion of prior authorization for regular, non-emergency ambulance transportation.

Here are six things to know:

  1. CMS plans to kick off its six-phase rollout of the new requirements on December 1. They will be in effect in all states by August 1, 2022.
  2. The prior authorization documentation is the same as it is for Medicare payment. But the agency will ask for it sooner.
  3. Providers can voluntarily request prior authorization from the Medicare Administrative Contractor for each instance of regular, non-emergency ambulance transportation. If they don’t, CMS will stop and review their claims before the fourth round trip within 30 days.
  4. Medicare has been testing prior authorization for regular ambulance service in Delaware, Maryland, New Jersey, Pennsylvania, North Carolina, South Carolina, Virginia, West Virginia and Washington, D.C.
  5. Prior authorization reduced unnecessary ambulance transportation and spending by over 70% during the test, cutting total Medicare spending by 2.4%. There weren’t any notable effects on health outcomes or patient access.
  6. Expanding the policy nationwide could save Medicare even more money, but it’s unclear how much because the savings varied widely by state during the pilot.


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