Billing Administration

Billing/Administration

Billing Contact: Lori Fall (1-315-701-7022)

Emergency Medical Services

Fleet Services

Billing/Administration Department

Rural/Metro Medical Services offers a complete billing department at our Syracuse Location that directly bills insurance companies for covered services. General guidelines to covered services are outlined below. Specific questions concerning covered services for a patient’s particular insurance should be directed to the patient’s insurance company or contact the Syracuse Billing Office directly at 1-800-961-9356.

Medicare

Emergency Ambulance Coverage

Medicare covers emergency transports by ambulance to a hospital if the situation meets Medicare’s definition of an emergency. Medicare defines an emergency as “the sudden onset of a medical condition manifesting itself by acute symptoms of such severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in any of the following:

Placing the patient’s health in serious jeopardy; or
Serious impairment of bodily functions; or
Serious dysfunction of any bodily organ or part.

Non-emergency Ambulance Coverage

Medicare presumes (or considers) that a transport is medically necessary if any of the following is true. If the patient meets medical necessity, a Physician Certification Statement must be filled out, signed, and given to the ambulance crew. The patient:

Was transported in an emergency situation as a result of accident, injury, or acute illness, or
Needed to be restrained (by means other than lap or seat belts), or
Was unconscious or in shock, or
Required oxygen or other emergency treatment on the way to his or her destination, or
Had to remain immobile because of a fracture that had not been set or the possibility of a fracture, or
Sustained an acute stroke or myocardial infarction, or was experiencing a severe hemorrhage, or
Was bed confined, or
Could only be moved by stretcher.

Services That Are Not Covered

There are some services that Medicare has clearly stated it does not cover. Examples of those services include:

	a nursing home to residence transport
	a convenience transport between facilities
	a transport from a residence with a physician’s office as the final destination

Medicaid

The following services are covered by Medicaid and may be ordered directly from Rural/Metro Medical Services:

	Emergency ambulance service
	Emergency and non-emergency ambulance service for dually eligible Medicare/ Medicaid patients whereby the patient meets Medicare’s criteria.
	Non-emergency ambulance service when the transport is being ordered through the medicaid office.

Non-emergency ambulance transport for Medicaid-only recipients need to receive prior authorization from the Medicaid Prior Authorization Office at 274-6606 which will then set up the transportation with an available vendor.

Blue Choice & Blue Cross/Blue Shield

Prior authorization is not needed for ambulance transports

Preferred Care

Preferred Care states that it will cover emergency ambulance services when medical attention and continuous medical monitoring is required during transportation. Indications for an ambulance transport may be reviewed on an individual basis for medical necessity and appropriateness by the Medical Director or designee. Non-emergent ambulance services are not a covered benefit. Ambulance services requires preauthorization only for non-emergent, non-life threatening situations.

Variations:

Ambulance Services are not a covered benefit for the following plans:

Access Plus

Basic Hospital and Medical

Hospital Services

1199 NBF- Wage Class III

Preferred Care Gold

Ambulance services for transfers to SNF is a covered benefit when medically necessary and medical services are provided during transport and the member is not in a position to refuse such transport.

These are general guidelines. Remember that it is recommended to confirm coverage with the patient’s insurance company prior to a non-emergency service being performed.