Things to remember....


Just thought I would publish a little reminder to everyone so no one becomes complacent….


Please reiterate to your crew members the importance of documentation concerning patient care and transport. In reviewing calls I have found some where there really needs to be more information documented in the narrative concerning the reason for the call,  assessment of the patient and any care provided to the patient on scene and enroute to the hospital.

The documentation needs to explain:

 Why were you dispatched, why was the ambulance requested

What was the patient complaining of or what was the pt complaining of at the time the ambulance was requested

Assessment of the pt – physical exam, any pain and how much pain per pain scale, any abnormal skin signs or cms. “See hosp records” for pertinent past history is not sufficient unless there is a copy of the hospital records attached to the run  report.

Any treatment performed and the result of the treatment (if oxygen was applied, why – how much – and did it help)

If hospital to hospital transport – what specifically does the patient need at the accepting facility that is not available at the first hospital; why does the patient need to go by ambulance between the two hospitals; assessment, treatment enroute, any needed interaction between the care provider and patient (repositioning, oxygen adjustment, airway management, restraints, wound management, etc.) and is the receiving hospital the closest available facility that can provide the needed treatment. 

Bottom line is the documentation needs to specifically explain and support why a patient needs to go by ambulance and could not have gone by any other means without endangering their health or making their condition worse.


Medicare continues to be strict in documentation rules and if the documentation does not establish the medical necessity for the patient to be transported by ambulance they are going to deny it. They may pay the claim to begin with but if/when they audit the claims and they determine documentation is not sufficient, they will take their money back. I recently had Medicare deny the transport of an unresponsive patient from the hospital to a nursing home for end of life care. Did I mention the pt was unresponsive? Their explanation: the patient’s vital signs were normal, airway was patent, breathing was normal, there was no documentation of need for any interaction between the health care provider and the patient during the transport so the patient could have gone by “stretcher van”. This claim is in the appeals process but last I heard they were close to 3 years behind in reviewing ALJ appeals. This is the thought process we are all up against….


We look at the documentation and if it does not meet Medicare’s medical necessity criteria we have to submit to Medicare with a modifier that tells them it was not medically necessary. They in turn will then deny as patient responsibility and the bill will go to the patient. A lot of times the patient then calls Medicare and Medicare tells them they did not have enough documentation. Guess who gets blamed? The ambulance provider gets blamed. There are calls where it was clearly not medically necessary – this fact also needs to be documented and explained so we can bill Medicare correctly.


We submit claims to Medicare on your behalf and we make every effort to make sure we submit them following Medicare and other payer rules. We submit claims based on the documentation you send us and we want to make sure you are getting reimbursed from Medicare for claims you should be and billing the patient for claims that Medicare should not be reimbursing for.


Thanks and please let me know if you have any questions,


Neil Frame NREMT-P/Operations Director

Metro-Area Ambulance Service, Inc.

Bismarck Air Medical, LLC.


Metro-Billing Services, LLP


Fax: 1-701-255-7247

"Always treat the patient, not the machine"