Ambulance: Who’s Looking at You

Описание: This training occurred 2/19/26.

Many different entities are performing medical review (MR) on ambulance suppliers. The review is to ensure the documentation supports medical necessity as defined in the Social Security Act. This webinar:
• Reviews who is looking at claims
• Explains what reviewers are looking for
• Provides resources to help in the future

Resources
CMS Additional Documentation Request webpage
https://www.cms.gov/data-research/mon...

WPS Responding to a Medical Review Additional Documentation Request (ADR) resource
https://www.wpsgha.com/guides-resourc...

CMS Comprehensive Error Rate Testing (CERT) webpage
https://www.cms.gov/data-research/mon...

WPS Medical Review Guides and Resources webpage
https://www.wpsgha.com/topics/medical...

OIG Workplan webpage
https://oig.hhs.gov/reports-and-publi...

CMS Medicare Fee for Service Recovery Audit Program webpage
https://www.cms.gov/data-research/mon...

CMS Supplemental Medical Review Contractor webpage
https://www.cms.gov/data-research/mon...

CMS Additional Documentation Request webpage
https://www.cms.gov/data-research/mon...

CMS Map: Review Contractor Directory - Interactive Map webpage
https://www.cms.gov/node/1243226

WPS Ambulance Documentation Requirements webpage
https://www.wpsgha.com/guides-resourc...

WPS sample PCS
https://www.wpsgha.com/forms/view/1000

CMS Advance Beneficiary Notice of Noncoverage webpage
https://www.cms.gov/medicare/forms-no...

Medicare Benefit Policy Manual, Chapter 10 - Ambulance Services
https://www.cms.gov/regulations-and-g...

Medicare Claims Processing Manual, Chapter 15 - Ambulance
https://www.cms.gov/regulations-and-g...

Medicare Program Integrity Manual, Chapter 6 – Medicare Contractor Medical Review Guidelines for Specific Services
https://www.cms.gov/regulations-and-g...

Chapters
00:00 Intro
03:22 Basic Medical Review Information
15:13 Entities Looking at Suppliers
43:41 Documentation Elements
55:55 Closing Comments