Review Of Medicare Part B Payments To Emergency Medical Services System

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether Emergency Medical Services System (EMSS) was paid by the Medicare program only for transporting beneficiaries to allowable facility destinations as defined by the Centers for Medicare and Medicaid Services's guidelines.  Our audit disclosed that EMSS incorrectly billed the Medicare program for transporting beneficiaries to unallowable facility destinations.  Based on a statistical sample, we estimated that EMSS claimed and received $19,929 of unallowable Medicare reimbursement.  The claims for unallowable services occurred Administrative Services (Noridian) because EMSS used incorrect destination modifiers on its Medicare claims.  We recommended that the Medicare carrier (i) recover the $19,929, and (ii) educate EMSS on the Medicare guidelines for allowable ground ambulance destinations and the correct use of destination modifiers.