CMS to extend prior authorization for ambulance transport: 4 things to know


CMS is expanding a payment model for nonemergent ambulance rides after it saved $650 million over four years and didn't disrupt access for beneficiaries.

Four things to know:

1. The Medicare prior authorization model for repetitive, scheduled nonemergent ambulance transport, or RSNAT, tests if prior authorization saves Medicare money while improving quality for repetitive ambulance services. 

2. Scheduled, repetitive ambulance services are often used by Medicare beneficiaries who need an ambulance ride to medical appointments. These types of ambulance transports are usually among the top Medicare Part B services with improper payments. 

3. Based on initial results, the prior authorization model, which began in multiple East Coast states, will be expanded nationally. Evaluations of its first four years found that the model reduced repetitive, scheduled nonemergent ambulance rides by 63 percent and lowered costs for the rides by 72 percent for patients with kidney failure or severe pressure ulcers.

4. Declaring the model "a resounding success" that beneficiaries across the country deserve to benefit from, CMS Administrator Seema Verma said: "When deployed appropriately, prior authorization can help ensure Medicare requirements are met before a service is provided and the claim is paid, without creating any new documentation requirements for providers." 

Read more here.

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