RSNAT and Prior-Authorizations = $$$

Beginning August 2022, the new Prior Authorization ruling for RSNAT (Regularly Scheduled Non-Emergency Ambulance Transports) patients will go into effect. What does this mean for you? We’ve compiled a list of important “to-dos” in regard to how to stay on top of recouping as much revenue as possible:

• Be sure to obtain a valid signature for EVERY trip (ESPECIALLY the initial trip)
• Do NOT copy and paste narrative. Be sure to be as detailed as possible. Providers will want to include how the consumer was appeared upon arrival, identify if the consumer was bed confined or if they needed ambulating, describe in detail the condition of the consumer at the time of transport. For instance, if they had any impairments, confusion, etc. Remember, remember to tell the story, pain the picture. 
• We HIGHLY recommend having contracts in place with nursing homes and facilities in your area. Why? If Medicare would deny your claim stating that it does not meet medical necessities and could be transported by other means, the transport would fall back onto the nursing home or facility.  Always request nursing home assessment form PRIOR to initial trip.
• Always obtain a  fully completed PCS PRIOR to transports and signed by a physician. 
• If you are transporting a new consumer, be sure their prior-auth with their previous provider has been CANCELLED before their initial trip with you is taken. If this does not happen, Medicare will deny your claims until the previous service prior-auth is cancelled. 
• Residential transports are more likely to get denied; we recommend obtaining an ABN form EVERY trip until the auth is approved.
• The first 3 RSNAT  round trips will covered, however, a fourth trip will be denied until Medicare approval has been obtained. We highly recommend complete your Quality Assurance and submissions to your billing service due to the time restraints of obtaining your prior authorization. 
• A prior authorization must be obtains every 60 days.

Keep in mind that you, the Proivder, cannot balance bill the consumer for any transports that are denied for prior authorization. This is why it is important to provide your billing service with the most up-to-date and detailed information possible. We hope you found this information helpful! If you have any questions regarding this information, please give us a call (330-874-1140).