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Medicare coverage of Ambulance Services

Medicare coverage of Ambulance Services aims to be consistent but requires some degree of interpretation and judgement to determine what claim should be submitted for ambulance billing purposes. Medical insurance (Medicare Part B) will cover an ambulance service from or to a hospital, a skilled nursing facility or critical access hospital but only when any other form of transport may endanger a patient’s health.

However, there are cases when Medicare may cover the services of an ambulance under the following circumstances:

  • If a patient needs to transport from their home or medical facility for health care for a condition where transportation by ambulance is required.
  • If a patient requires dialysis, or an end-stage renal disease, and requires ambulance transport to or from a dialysis facility, in the event that any other form of transport is likely to endanger the patient’s health.

Under the Medicare coverage of Ambulance Services guidelines, Medicare will only cover an ambulance service to an appropriate medical facility that is closest to the patient and can provide the necessary treatment and care. If a patient decides they wish to use a facility further away, the Medicare payment is based on the normal charge to the facility that was closest.

In cases where the care that is required is not available in the local area, transport to the closest facility that can offer the required care outside the local area will be covered by Medicare.

Medicare coverage of Ambulance Services may provide cover for an emergency ambulance transport, in the cases where the condition places a serious threat to the patient’s life. Such cases may include unconsciousness, in shock, bleeding or in severe pain. The bottom line is just how serious a patient’s condition is at the time and if an alternative method of transportation was considered more appropriate.

Health Provision – US versus UK

Health Provision – US versus UK

This week, ABS Inc  are looking at the difference in two nations regarding the health service that could not be any bigger, and there is always an on-going debate about the United States system of health provision compared to the National Health Service (NHS) that has been provided to the citizens of the United Kingdom following the 2nd World War. The main difference being that UK citizens pay taxes and National Insurance (NI) payments from their salary and receive free health, ambulance, fire and police services. They still have to make a contribution toward prescribed medicines but this is a flat fee and the remainder is subsidized by the NHS.

However, the NHS is not a not a perfect system and funding always features very high on the politicians agenda. Money is always needed to recruit and train more staff or update equipment. Doctor’s surgery’s and hospitals frequently see long delays in the consultation and treatment of patients and as much as the general public in the UK appreciate the NHS, private health care similar to that in the US has surfaced. The system is based on medical insurance payments in advance so the “potential” patient still pays in advance for medical and ambulance services but this is in addition to their tax and NI payments. These people are still fully entitled to NHS services should they choose to but the public sector typically offers better facilities and accommodation with private room for the patient to stay during treatment.

Private health is not especially expensive in the UK but as it is an addition to other taxes many people are either resistant to the idea or feel they cannot afford the additional cost. In the US though, citizens do not have the same excuse for not protecting themselves with medical insurance that becomes necessary for payments, should they be admitted to hospital or require ambulance or fire services.

ABS Inc will continue on this theme next week and look at why people should invest in medical insurance and why the US system could be considered better than the UK’s adopted NHS.