Ala. Admin. Code r. 480-5-5-.34

Current through Register Vol. 43, No. 1, October 31, 2024

Section 480-5-5-.34 - Ambulance Services

(1) All non-emergency ground and air ambulance service rendered to workers' compensation claimants shall be pre-certified. Emergency ground and air ambulance services shall be retro-certified within 24 hours of the service or on the next working day.

(2) All ground and air ambulance services shall be medically necessary and appropriate. Documentation, trip sheet(s), shall be submitted with the bill that states the condition(s) that indicates the necessity of the ground or air ambulance service provided. It should readily indicate the need for transport via this mode rather than another form of transportation. The service billed shall be supported by the documentation submitted for review.

(3) Reimbursement shall be made if the injured employee expires while enroute to or from a health care facility. Reimbursement shall not be payable if the responding ambulance or air ambulance service did not transport the injured employee, or if the employee was pronounced dead by a legally authorized individual prior to transport.

(4) Billing for services shall be submitted to the payer on a properly completed HCFA 1500 claim form by HCPCS code. Hospital based or owned providers must submit the charges on a HCFA 1500 by HCPCS code.

(5) Reimbursement shall be:

(a) Based upon the lesser of the submitted charge or the Prevailing Reimbursement/Maximum Fee Schedule for Ambulances. These payments shall not exceed the prevailing charges in that locality for comparable services under comparable circumstances; and,

(b) Commensurate with the services actually performed. Services rendered are independent of the type of call received or the type of staff and/or equipped ambulance responding.

Author: Workers' Compensation Medical Services Board

Ala. Admin. Code r. 480-5-5-.34

New Rule: Filed July 14, 1997; effective August 18, 1997.

Statutory Authority:Code of Ala. 1975, § 25-5-293.