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Chasing ambulance compliance: Strategies for risk mitigation

Sarah L. Mancebo (sarah.mancebo@adventhealth.com) is Director of Compliance at AdventHealth in Orlando, FL.

A recent emergency medical services annual conference highlighted the revolution that is underway for ambulance transport. It is no longer about getting an individual as quickly as possible to a hospital for treatment. Today’s ambulance providers and suppliers are providing more advanced patient care in the field and are becoming more integrated in the healthcare system. The revolution that ambulance transport is undergoing makes it ever so important to bring compliance to the conversation.

Ambulance suppliers and providers that are enrolled in Medicare need to understand that billing and reimbursement requirements are a challenging and risky compliance area for Medicare, because: (1) the laws and regulations are both lengthy and complex, (2) the Office of Inspector General (OIG) has heightened its focus and review of ambulance claims in recent years, and (3) enforcement actions are trending across the ambulance industry. Each of these categories is briefly summarized below.

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