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:
- 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.
- The prior authorization documentation is the same as it is for Medicare payment. But the agency will ask for it sooner.
- 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.
- 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.
- 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.
- 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.