February 14, 2023
Medical Documentation for RSNAT Prior Authorization and Claims
The prior authorization process for repetitive scheduled non-emergent ambulance transport (RSNAT) in jurisdiction 15 began August 1, 2022. This process did not change the documentation requirements for demonstrating medical necessity.
Physician Certification Statement (PCS) for Repetitive Services
- Must be signed by a physician and properly credentialed (MD or DO)
- Signed within 60 days prior to the requested or start of service date
- Ambulance company’s responsibility to maintain a current PCS
Prior Authorization Request Reviews
The documentation requirements for prior authorization requests need to support the PCS and be as current and up to date as possible. Medical documentation for prior authorization requests consists of the PCS and may include one or more of the following:
- Physician progress notes
- Nursing progress notes
- Skilled Nursing Facility documentation
- Completed and signed MDS
- Activities of Daily Living (ADL) sheets
- Therapy progress notes
- PT/OT evaluations
- Home Health medical documentation
- Any medical documentation outside of the ambulance company
RSNAT Prepay/Post-pay Claim Reviews
The documentation requirements for prepay/post-pay claim reviews are slightly different. When responding to documentation requests, ambulance providers should submit the following:
- A valid PCS to coincide with the date of service on the claim
- The same types of medical documentation listed for prior authorization requests
- Ambulance transportation/run sheets
Non-Medical Documentation
Non-medical documentation which cannot be accepted for prior authorizations or claim reviews include:
- Any letter from a family member, physician, nurse, etc.
- Email communications
- A generalized note/side note
- Anything that is outside acceptable medical documentation
Resources:
- 42 CFR § 410.40 Coverage of Ambulance Services
- Medicare Benefit Policy Manual Chapter 10 § 10.2.4 Necessity and Reasonableness- Documentation Requirements
- Medicare Program Integrity Manual Chapter 3 § 3.2.3 Requesting Additional Documentation During Prepayment and Postpayment Review
- Medicare Program Integrity Manual Chapter 3 § 3.2.3.8 Additional Documentation Requests
- Repetitive Scheduled Non-Emergent Ambulance Transport Prior Authorization Operational Guide
Join Electronic Mailing List
Print
Bookmark
Email
Facebook
YouTube
LinkedIn
CGS Medicare Mobile App