EMS Reimbursement Update September 2012

 Physician Certification Statement

Medicare requires a Physician   Certification Statement (PCS) for all non-emergency transports.  This   includes transportation to and from a physician’s office, dialysis center,   diagnostic or theraputic center, discharge from a facility and most   inter-facility transportation.

 Repetitive Patients

Repetitive is defined as three   or more transports within a ten day period or once a week for three   weeks.  For repetitive patients, the PCS must be signed by an MD prior to the first transport and   is valid for 60 days from the date in which the PCS is signed.

 Non-Repetitive Patients

The PCS should be signed by the  patient’s attending physician; however, if the form can not be obtained by   the attending physician, the statement may be signed by an RN, PA, NP, CNS or   discharge planner with knowledge of the patient’s condition at the time the   transport is being provided.

Invalid PCS Forms

EMSMC reviews PCS forms to determine their validity. Through a weekly report, our clients receive a list of claims that were not billed based on a missing or invalid PCS form.

Most Common Reasons for Return

• Inconsistency/Contradiction to the Patient Care Report
  • PCS states bed-confined while the PCR states the patient is able to sit in a chair/wheelchair, get up from bed without assistance, and/or ambulate
  • PCS states reason for transport that is not documented within the PCR such as contractures, behavioral/altered mental status, need for oxygen, etc.
• Credentials of Signor have not been identified or do not meet credentials listed above
• Signature is not dated or date is after the date of transport for repetitive transports
• Signature appears to be a copy of previously signed PCS forms
• PCS form does not provide enough information. The form must state the medical reason in which the transport is necessary.

PCS   Form

While Centers for Medicare and   Medicaid Services (CMS) requires the form be obtained, they did not mandate a   certain form for use in obtaining this information.

EMSMC recommends the recently   updated Page, Wolfberg, Wirth (PWW) EMS Law Firm form that is available on   their website in Word and PDF versions. The form should be customized to   include the name of the EMS agency and/or Logo.

This form is strongly   recommended as it provides the necessary fields in order to meet CMS   requirements in an easy-to-follow format for the signor.

A link to the form is listed here: Sample PCS Form