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 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.
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
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