Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization and Pre-Claim Review Initiatives
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT)
Background
Prior authorization helps ambulance suppliers ensure that their services comply with applicable Medicare coverage, coding, and payment rules before services are rendered and before claims are submitted for payment.
Prior authorization does not create new clinical documentation requirements. Instead, it requires the same information that is already required to support Medicare payment, just earlier in the process. Prior authorization allows providers and suppliers to address issues with claims prior to rendering services and submitting claims for payment, which has the potential to reduce appeals for claims that may otherwise be denied.
Prior authorization for RSNAT is voluntary. However, if an ambulance supplier elects to bypass prior authorization, applicable RSNAT claims will be subject to a prepayment medical review. Claims for the first three round trips are permitted to be billed without prior authorization and without being subject to prepayment medical review.
Resources for Ambulance Suppliers
The Ambulance Operational Guide National Expansion (PDF) provides operational details about the RSNAT Prior Authorization model.
Additionally, ambulance suppliers can share an Ambulance Prior Authorization Physician/Practitioner Letter (PDF) with physicians and other entities to help ensure that they obtain the necessary documentation in a timely manner.
Contact Us
Ambulance suppliers can email questions to AmbulancePA@cms.hhs.gov.
Timeline & Updates
Updates are provided in reverse chronological order; scroll down for earlier updates.
Update 11/14/2024:
The following changes will be effective January 9, 2025:
- The standard prior authorization review timeframe will change from 10 business days to 7 calendar days.
- The option to request an expedited prior authorization review will be removed, as prior authorization requests under this model are for non-emergent services that are scheduled in advance and do not meet the criteria for an expedited review.
Stats on RSNAT Prior Authorization model: 09/15/2023
CMS is releasing updated stats on the RSNAT Prior Authorization model.
Please click here to see the results. (PDF)
Special Open Door Forum: 10/19/2021
CMS hosted a Special Open Door Forum call to discuss the upcoming national expansion of the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model on Thursday, October 28 from 2:00-3:30 pm Eastern Time. Presentation materials can be found in the Downloads section. For more information, please visit the Special Open Door Forums webpage.
Nationwide Expansion Implementation Dates: Updated 11/30/2021
The Centers for Medicare & Medicaid Services (CMS) announced the implementation dates for all remaining states and territories for the nationwide expansion of the RSNAT Prior Authorization Model. The model began:
- On December 1, 2021 in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas;
- On February 1, 2022 in Alabama, American Samoa, California, Georgia, Guam, Hawaii, Nevada, Northern Mariana Islands and Tennessee;
- On April 1, 2022 in Florida, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, Puerto Rico, Wisconsin, and U.S. Virgin Islands;
- On June 1, 2022 in Connecticut, Indiana, Maine, Massachusetts, Michigan, New Hampshire, New York, Rhode Island, and Vermont; and
- On August 1, 2022 in Alaska, Arizona, Idaho, Kentucky, Montana, North Dakota, Ohio, Oregon, South Dakota, Utah, Washington, and Wyoming; and nationwide for Railroad Retirement Board beneficiaries.
Please continue to check this website and with your Medicare Administrative Contractor (MAC) for upcoming educational opportunities. For additional information on the prior authorization process, please refer to the Operational Guide and Frequently Asked Questions in the Download section below.
CMS to Expand Model Nationwide: 9/22/2020
On Sept. 22, 2020, CMS announced that it will expand the RSNAT Prior Authorization Model nationwide, as the model has met all expansion criteria.
CMS also released the model’s Second Interim Evaluation Report. The report found that the model was successful in reducing RSNAT services and total Medicare spending while maintaining overall quality of, and access to, care.
In March 2018, the Chief Actuary for CMS certified (PDF) that nationwide expansion of the model would reduce net program spending under the Medicare program. Based on this certification and Interim Evaluation Reports, the Secretary of Health and Human Services determined that the model met the statutory criteria for expansion.
CMS to Resume Model Activities: 07/07/2020
Given the importance of prior authorization activities to CMS’ program integrity efforts, CMS discontinued exercising enforcement discretion for the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model beginning on August 3, 2020, regardless of the status of the public health emergency (see additional information in the COVID-19 Provider Burden Relief FAQs (PDF). Effective for claims submitted on or after August 3, 2020, CMS will resume full model operations including prepayment review if prior authorization has not been requested by the fourth round trip in a 30-day period.
Following resumption of the model, the Medicare Administrative Contractors will conduct postpayment review on claims that were subject to the model that were submitted and paid during the pause without prior authorization. CMS will post more information on the postpayment review process in the near future.
Assistance with Alternative Transportation Resources: 06/30/2020
Medicare beneficiaries who don’t qualify for RSNAT coverage may be eligible for transportation services under Medicaid or Programs of All-inclusive Care for the Elderly (PACE).
Additionally, Medicare beneficiaries can contact Eldercare at 1-800-677-1116, or their local State Health Insurance Assistance Program, to ask about other state and local services.
COVID-19 Public Health Emergency Update: 03/31/2020
On March 30, 2020, CMS announced a pause of certain claims processing requirements for the RSNAT Prior Authorization Model in the model states of Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia until the Public Health Emergency for the COVID-19 pandemic has ended. Read the COVID-19 Provider Burden Relief FAQs (PDF) for more details.
Inclusion of Additional States: 12/15/2015
Section 515(a) of MACRA added Delaware, the District of Columbia, Maryland, North Carolina, Virginia, and West Virginia to the model on December 15, 2015, for transports occurring on or after January 1, 2016.
Initial Implementation: 12/1/2014
CMS first implemented the RSNAT Prior Authorization Model in South Carolina, New Jersey, and Pennsylvania on December 1, 2014, for transports occurring on or after December 15, 2014. The model originally began as a CMS Center for Medicare and Medicaid Innovation Center model under section 1115A of the Social Security Act (the Act) that tested whether prior authorization helps reduce expenditures, while maintaining or improving access to and quality of care.
Results
Spending and Affirmation Rate Results 10/19/2021
CMS released updated spending and affirmation rates from the first six years of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport. Please see the results in the “Downloads” section below.
Spending and Affirmation Rate Results 11/18/2020
CMS released updated spending and affirmation rates from the first five years of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport. Please see the results in the "Downloads" section below.
Spending and Affirmation Rate Results 11/08/2019
CMS released updated spending and affirmation rates from the first four years of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport. Please see the results in the "Downloads" section below.
Spending and Affirmation Rate Results 10/26/2018
CMS released updated spending and affirmation rates from the first three years of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport. Please see the results in the "Downloads" section below.
Spending and Evaluation Results 02/12/2018
CMS released spending and affirmation rates from the first two years of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport. Please see the results in the "Downloads" section below.
An evaluation of the model is also being conducted as required by Section 1115A of the Social Security Act. CMS released the First Interim Evaluation Report of the Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport. Please see the Ambulance Prior Authorization Model First Interim Evaluation Report in the “Related Links” section below.
Spending and Affirmation Results 04/07/2016
CMS released spending and affirmation rates from the first year of the Prior Authorization Model for Repetetive, Scheduled Non-Emergent Ambulance Transport. Please see the results in the “Downloads” section below.
Downloads & Links
Downloads
- Ambulance Prior Authorization FAQs (PDF)
- Ambulance Prior Authorization Physician/Practitioner Letter (PDF)
- Ambulance Operational Guide National Expansion (PDF)
- Spending and Affirmation Rate Results 10-19-2021 (PDF)
- Spending and Affirmation Rate Results 11-18-2020 (PDF)
- Spending and Affirmation Rate Results 11-08-2019 (PDF)
- Spending and Affirmation Rate Results 10-26-2018 (PDF)
- Spending and Affirmation Rate Results 02-12-2018 (PDF)
- Spending and Affirmation Rate Results 04-07-16 (PDF)
- Example Ambulance Prior Authorization Letter Mailed to Beneficiaries (PDF)
Related Links
- Ambulance Prior Authorization Model Second Interim Evaluation Report
- Ambulance Prior Authorization Model First Interim Evaluation Report
- CMS Partners Fact Sheet (PDF)
- Federal Register Notice Expansion 2020
- Federal Register Notice 1-Year Extension 2019
- Federal Register Notice 1-Year Extension 2018
- Federal Register Notice 1-Year Extension 2017
- Federal Register Notice 2015
- Federal Register Notice 2014
- Final Evaluation Report of the Medicare Prior Authorization Model
- MLN Fact Sheet – National Expansion of the RSNAT Prior Authorization Model (PDF)
Page Last Modified:
11/13/2024 03:15 PM