On July 12, 2007, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule regarding Medicare patient signature requirements for ambulance services.  The Proposed Rule is actually contained in a much larger document that also contains changes to the Physician Fee Schedule. 

The Proposed Rule would allow ambulance providers to submit a claim to Medicare without an "assigment of benefits" signature from the patient when the patient is unable to sign, provided that: (1) no other authorized signer was available or willing to sign; and (2) the ambulance service maintains documentation in its files for a four-year period including:

     (i) a "contemporaneous statement" from an employee of the ambulance service that none of the authorized signers were available or willing to sign;

     (ii) a "signed contemporaneous statement from a representative of the facility that received the beneficiary, which documents the name of the beneficiary and the date and time the beneficiary was received by that facility"; and

     (iii) documentation with the date and time the beneficiary was transported, and the name and location of the facility that received the beneficiary.

There is little doubt that the second requirement - a signed statement from a representative of the facility that receives the patient - will generate a great deal of controversy and concern among ambulance providers.  CMS is accepting comments on the Proposed Rule until August 31, 2007.   Detailed instructions on how to submit comments are included in the PWW summary of the Proposed Rule, which you can download below.

The Proposed Rule would also eliminate the annual publication of the Ambulance Inflation Factor (AIF) in the Federal Register, and allow CMS to publish the AIF on its website.  CMS believes this will facilitate more rapid publication of the annual inflation adjustment than is currently possible.

You can download the entire rule - in sections - in PDF format by clicking the links below.  However, PWW has also prepared an excerpt of the ambulance-related portions of the Proposed Rule from the July 12th Federal Register.  This compilation is much shorter - and easier to digest - than the Federal Register version.

Ambulance Excerpts of the July 12th Proposed Rule
(Summary Document Prepared by PWW - 9 pages)
                
        CLICK HERE for PDF Version            CLICK HERE for WORD VERSION

Complete Proposed Rule From July 12th Federal Register
(273 pages - Six Sections - PDF Format)

        Section 1
        Section 2
        Section 3
        Section 4
        Section 5
        Section 6