CMS Clarifies DOS for Ambulance Services

The Centers for Medicare & Medicaid Services (CMS) reminds providers not to submit claims for services performed on deceased Medicare beneficiaries. And why not?

Consider, for example, a case where an ambulance is dispatched at 11:50 p.m. and arrives at its destination at 12:05 a.m. Within that 15-minute interval, the individual requiring assistance dies.

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An ambulance transport’s date of service (DOS) is generally the date the loaded ambulance vehicle (ground or air) departs the point of pickup. If the ambulance puts the arrival time as the DOS, however, Medicare will deny the claim because, in most cases, there must be a transport of a living Medicare beneficiary for the service to be considered a covered Medicare service.

If an ambulance services claim is received with a DOS one or more days beyond the beneficiary’s date of death (DOD) (according to the Master Beneficiary Record (MBR) within the Common Working File (CWF)), the claim is denied.

A transport by ambulance of a deceased Medicare beneficiary is not a covered service unless it meets the requirements in the Internet Only Manual Publication 100-02, Chapter 10, Sections 10.2.6, 10.4.1, or 10.4.9.

Avoid Denial

In a ground transport case, if the beneficiary is pronounced dead after the vehicle is dispatched but before the (now deceased) beneficiary is loaded into the vehicle, then the DOS should be the dispatch date. (Special payment policies apply per Pub. 100-02, Chapter 10, Section 10.2.6). To receive the provider’s or supplier’s BLS base rate, mileage or rural adjustment, use the QL modifier Patient pronounced dead after ambulance called when submitting the claim.

In an air transport case, if the beneficiary is pronounced dead after the aircraft takes off to pick up the beneficiary, then the DOS should be the date of takeoff. (Special payment policies apply per Pub. 100-02, Chapter 10, Section 10.4.9).

This guidance is based on CMS Transmittal 1682, Change Request (CR) 6372, dated Feb. 13. See also CMS Transmittal 103, CR 6318, issued Feb. 20, for changes to ambulance services in Pub. 100-02, Chapter 10 due to the termination of the fee schedule transition period.

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One Response to “CMS Clarifies DOS for Ambulance Services”

  1. Terri Erickson, CPC says:

    Again, in plain english.. Ambulance services where dispatch occurs prior to the pronouncement of death are covered at the BLS rate with a -QL modifier. However, we can not get these claims paid due to a Trailblazers edit, which denies claims before even being allowed in the Trailblazers’ system due to no mileage. Trailblazers continually blames our clearinghouse, however, our clearinghouse has already relaxed their edit in regards to ambulance and no mileage. Trailblazer has even gone so far as to tell us to just add a mile to avoid the edit. It seems to me that Trailblazers needs to get their act in gear and relax their edit.

    Tired of getting the Trailblazers’ run around!

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