Sunday, September 19, 2010

What locations can I get Medicare-covered ambulance transportation to and from?





Medicare may cover ambulance transport to and from certain locations that are within your service area and able to provide you with the care you need.
 
The service area is the geographical region around a facility that contains most of the patients whom the facility serves. For example, if you live in a town with a small community hospital and there is a larger urban hospital 20 miles away, the larger hospital would be part of your service area if it regularly serves people who live in your town.
Medicare will cover ambulance services to and from the following locations within your service area:
From… To…

Your home, or any other place where the need arose… the closest appropriate hospital or skilled nursing facility (SNF).

A hospital or SNF… your home if the facility is the closest appropriate one in relation to your home.

A SNF… the nearest medical provider, if the SNF cannot provide you necessary treatment and the cost of transport is less then bringing the treatment to you, and back.

Your home… the nearest appropriate renal dialysis facility, and back.

Note: If your service area does not have a facility that is adequately equipped or capable of treating you, transport to the closest appropriate facility outside of your service area will be covered. However, Medicare will not pay for an ambulance transport to a hospital outside of your service area just so you can receive care from a particular doctor if the nearby hospital can treat you.

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download