Certified Revenue Cycle Representative (CRCR) Practice Exam

Ambulance services are billed directly to the health plan for which of the following?

1. All pre-admission emergency transports

2. Transport deemed medically necessary by the attending paramedic-ambulance crew

3. Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge

4. The portion of the bill outside of the patient's self-pay

The correct answer is: Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge

Billing ambulance services directly to the health plan is typically appropriate for services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge. This distinction is important because health plans often cover ambulance services that are part of the continuum of care surrounding a hospital stay. When a patient has been discharged from the hospital, the ambulance service arranged for their transport home or to another facility directly relates to the medical care they received, and health plans generally recognize this as a medically necessary service. Additionally, ambulance transport prior to admission is often critical in emergency situations and is usually considered part of the initial treatment by healthcare providers. This understanding aligns with insurance policies that dictate coverage based on medical necessity and the context in which the services are provided. Therefore, it is appropriate for these ambulance services to be billed to health plans as they are integral to patient care during transitions, either before admission or following discharge.