Avoiding Ambulance Claims Issues

This webinar occurred on 3/25/26. WPS data analysis shows over $50,000,000 in ambulance claim denials for the last quarter of 2025. Let us explain the denials and provide tips for avoiding them. We will: • Define the data used to determine the denials • Provide the most common denials • Show resources to help you avoid these denials Resources Medicare Claims Processing Manual, Chapter 16 - Laboratory Services, Section 90.2 AND 90.3 https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c16.pdf CMS SNF Consolidated Billing webpage https://www.cms.gov/medicare/coding-billing/skilled-nursing-facility-snf-consolidated-billing Medicare Claims Processing Manual, Chapter 1 - General Billing Requirements ,Section70 - Time Limitations for Filing Part A and Part B Claims https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c01.pdf SNAP User Manual https://www.wpsgha.com/tools/portal-user-manual DDE Overview https://www.wpsgha.com/guides-resources/view/511 Medicare Claims Processing Manual, Chapter 15 – Ambulance, Section 30 A https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c15.pdf WPS Ambulance Documentation Requirements Article https://www.wpsgha.com/guides-resources/view/267 WPS Prior Authorization for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) resource https://www.wpsgha.com/guides-resources/view/804 RRB Specialty MAC Providers webpage https://palmettogba.com/rr CMS MA Plan Directory webpage https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/ma-plan-directory Chapters 00:00 Intro 03:22 Date Explanation 10:44 RTP Data 19:48 Rejected Data 26:36 FISS Denials Date 33:12 Unprocessable 39:58 MCS Denials 47:32 Resources 50:28Questions and Answer