BILLING

Medevac Alabama Inc. operates as Medevac International according to a DBA (doing business as). Specifically, Medevac Alabama is an independent company which operates under the Medevac International brand. Similarly, there are other companies that operate as Medevac International. We can be thought of similar to your local fast-food franchise. They have the same sign and operate in all same fundamental ways. They share the same unified mission, and yet are not the same business. This is meant to say that Medevac Alabama operates and bills independently of all other Medevac International entities and has a different charge master, following rules and polices that are inherent only to Medevac Alabama.

This will be written on any official invoice you receive, as well as on the vehicles themselves. At the moment, if you are transported by ground in Alabama, then it is by the Medevac Alabama ground ambulance service. Take comfort and reassurance in the fact that all Medevac operations are family owned and family run. The founder of the company has standard when it comes to billing. He calls it the grocery store test. Essentially, treatment and transport by our ambulance service should be akin to a nice grocery store. Customers should be able to easily navigate the store, finding the products they need, and have confidence in what it costs when it's time to check out. It should be a safe and repeatable experience. This service is standard, regardless the operation.

Many of our competitors are large multi-national conglomerates funded by venture capitalism. We are not. We are a family organization. By utilizing our services, you are supporting family run and locally operated organization. The bottom line is we value your business and strive to exceed your expectations.

(See Below)

How to read the table:

Each ambulance transport is composed of two parts: loading and mileage. There are other potential charges, but they are infrequently used. We will, however, explain every line item.

Loading rate: Loading rate consists of the base rate, level of service provided—BLS, ALS, or SCT—as well as the nature of transport—whether the call is emergent or non-emergent. The level of care in addition to the nature of transport are determined based upon Medicare (CMS) rules.

Consider the following: A BLS, non-emergent transport that is 8 miles long.

720 + (20 x 8) = $880.00 --> where loading + (mileage x loaded miles)

This is what would be billed to insurance, a private person, or facility without a contract for service. Insurances will interpret the bill differently, and we will accordingly discuss as many of those as we can. The patient, however, is ultimately responsible for any payment that the insurance does not pay, unless there is a contractual or regulatory write-off involved. Such instances will also be explained elsewhere.

Other charges

Non-covered mileage all levels of service: This would be a charge where insurance has determined that part of a transport is medically necessary, but that part of the mileage is not. Such an instance could be in the event a closer hospital is bypassed for another more distant one based on preference. Such a situation could deem a portion of the mileage appropriate and leave another to be non-covered.

Extra ambulance attendant: This is when additional personnel are required beyond the typical 2 person ambulance team. Such scenarios might occur when a Medevac RN needs to go with the patient, or if a patient requires multiple Medevac personnel to lift, or the patient requires other special handling. Note: Students and trainees often accompany our primary ambulance crews for educational and training purposes. The patient will NEVER be billed in such instances.

Ambulance response; treatment-no transport: This would be a scenario where a patient was treated on-scene but they were not transported. This is only billed in a scenario in which ALS care was provided. A specific case could be if Dextrose was administered to an unconscious diabetic patient, the patient came to, and requested not to be transported to the hospital.

Ambulance waiting time—30 minutes free: Billed in 30-minute intervals. This could be for an extended wait at a doctor's office or another wait-and-return event. This code is for when the patient is no longer being transported but the ambulance crew could not leave the patient. The first 30 minutes is without charge, but following may be billed in half-hour intervals. Note, however, that courtesy wait-and-returns are often performed, in which case crews choose to stay with the patient out of convenience or courtesy. The instances in which we would bill are those in which it is not possible for us to leave, whether it be for patient need such as in the case of a patient being on a ventilator, or an instance in which the facility demands that we stay with the patient.

(See Below)

NOTE: No payment plans are accepted when paying for service directly at the reduced rate. Medevac Alabama Inc. must be promptly paid in full prior to transport, or facility must have a contract in good standing to obtain direct payment prices. 

How to read the table:

Just as in the case of the patient having insurance, each ambulance transport is composed of two parts: loading and mileage. There are other potential charges, but they are infrequently used. We will, however, explain every line item.

Loading rate: Loading rate consists of the base rate, level of service provided—BLS, ALS, or SCT—as well as the nature of transport—whether the call is emergent or non-emergent. The level of care in addition to the nature of transport are determined based upon Medicare (CMS) rules.

Consider the following: A BLS, non-emergent transport that is 8 miles long.

300 + (12 x 8) = $396.00 --> where loading + (mileage x loaded miles) {This is about 48% savings over the standard charge master}

This is essentially the amount Medicare pays for transportation. To honor this price, however, we must be paid at the time of service, or the facility must have a contract. In instances that your facility does not have a contract and is responsible for an ambulance bill, we look at postdating contracts on a case-by-case basis. 

Other charges

Non-covered mileage all levels of service: This would be a charge where insurance has determined that part of a transport is medically necessary, but that part of the mileage is not. Such an instance could be in the event a closer hospital is bypassed for another more distant one based on preference. Such a situation could deem a portion of the mileage appropriate and leave another to be non-covered.

Extra ambulance attendant: This is when additional personnel are required beyond the typical 2 person ambulance team. Such scenarios might occur when a Medevac RN needs to go with the patient, or if a patient requires multiple Medevac personnel to lift, or the patient requires other special handling. Note: Students and trainees often accompany our primary ambulance crews for educational and training purposes. The patient will NEVER be billed in such instances.

Ambulance response; treatment-no transport: This would be a scenario where a patient was treated on-scene but they were not transported. This is only billed in a scenario in which ALS care was provided. A specific case could be if Dextrose was administered to an unconscious diabetic patient, the patient came to, and requested not to be transported to the hospital.

Ambulance waiting time—30 minutes free: Billed in 30-minute intervals. This could be for an extended wait at a doctor's office or another wait-and-return event. This code is for when the patient is no longer being transported but the ambulance crew could not leave the patient. The first 30 minutes is without charge, but following that we may bill in half-hour intervals. Note, however, that courtesy wait-and-returns are often performed, in which case crews choose to stay with the patient out of convenience or courtesy. The instances in which we would bill are those in which it is not possible for us to leave, whether it be for patient need such as in the case of a patient being on a ventilator, or an instance in which the facility demands that we stay with the patient.

There are two primary categories of transports Medicare is concerned with, those that are considered medically necessary and those which are considered non-medically necessary. The former includes instances such as 911 calls, transfers to an upgrade-in-care, as well as the transportation of a bed-bound patient to a lower level of care. The latter includes instances where we to transport to non-covered locations like doctor's offices, transports for convenience, etc.

For medically necessary transports, the Medicare beneficiary does not need to be concerned with what is charged as most ambulance services—including this one—accepts Medicare. As long as the patient has Part B coverage, the transport is by CMS guidelines considered to be medically necessary, and its deemed reasonable and necessary, then the bill will be received and paid by Medicare at the Medicare allowable.

This allowable rate, however, varies by the zip code the patient is picked up in and the level of service required. The Medicare beneficiary, or their secondary insurance, will receive a bill for the co-payment (20%) at the Medicare allowable price. 

For non-medically necessary transports, our crew will generally do their best to notify the patient of non-covered services through the presentation of an Advance Beneficiary Notice (ABN). This is a form which states that the service the patient is going to receive is not generally covered and gives the patient an estimate of the costs. Crews will NEVER give the patient an ABN for any emergency call. Emergency calls are generally considered to be 911 calls, upgrades-in-care to an emergency department (ED), or transports to an intensive care unit (ICU) for specialized care.

According to Medicare, "an Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give [the patient] before [the patient] receive[s] a service if, based on Medicare coverage rules, [the patient's] provider has reason to believe Medicare will not pay for the service" (Medicare Interactive, n.d.).

Crews will NEVER give the patient an ABN for any emergency call. Emergency calls are generally considered to be 911 calls, upgrades-in-care to an emergency department (ED), or transports to an intensive care unit (ICU) for specialized care.

The patient may receive an ABN for the following:

• Non-covered destination: Medicare does not cover transports to doctors' offices for instance.

• Non-bed bound status: Medicare requires patients going to a lower level of care to be either bed-bound or in a condition that transportation by any other means could be hazardous to their health.

• Non-closest facility: This is one is somewhat tricky. Medicare will pay for trips to the closest appropriate facility (CAF). CAF applies when care can be provided at a hospital that is closer, so a hospital that is 100 miles away as opposed to 50 miles for instance. CAF is not questioned on nominal distances, however, such as the case of a few miles. Should there be a question of CAF, it is vital that we receive adequate documentation from the sending facility. Don't hesitate to reach out to our billing team if you believe CAF has been misapplied. Oftentimes, CAF is an issue of the proper documentation.

ABNs will have a true estimate of the potential cost of the transport. There are three potential choices:

1. We can bill Medicare for an official decision. However, if we bill Medicare, the amount we bill the patient must equal the amount we bill Medicare. Therefore, the bill will reflect the full cost of service. If Medicare decides that the service is indeed covered, than any money prepaid by the patient is returned—less any applicable co-payments or deductibles. If Medicare denies the claim, we will appeal on the patient's behalf. If Medicare denies the appeal, the patient can request the payment be changed to the reduced charge master (direct payment price.) This will only be granted in the event of immediate payment of the entire balance due. A reasonable amount of time between notification and expected payment will be provided. It is important to communicate with the billing team to arrange prompt payment to ensure direct payment eligibility.

2. We can choose not to bill Medicare for an official decision. Keep in mind this option cannot be appealed to Medicare at a later time. If the patient wishes to pay immediately, the transport will be provided at the reduced direct payment pricing. If the patient wishes to make payments, the price will be set at the full charge master. Further a down payment may be required depending on the distance and cost associated. This amount will be determined by the billing team.

3. The patient refuses transport altogether.

For more information on ABNs please see the following. 

Long distance and out of town transport place a substantial financial risk on the company. In a time of rising costs and shrinking reimbursements, transporting patients more than 100 miles means a substantially higher risk of being under-compensated or receiving no compensation at all. Careful documentation is required in these cases to ensure that your transport meets medical necessity as defined by the patient's insurance company. Patients should also understand that there is an increased chance of facing higher co-payments, deductibles, and denials of claims if the transport is greater than 100 miles. 

Generally speaking, transports to a doctor's office are only covered by Medicaid. Further, they are only covered when the patient is, by CMS guidelines, bed-bound. To be considered:

1. The patient must be unable to get up from the bed without assistance; AND

2. The patient must be unable to ambulate without assistance; AND

3. The patient must be unable to sit in a chair or wheelchair.

There are only a few very unlikely scenarios in which Medicare will pay for such transports. Some private insurance companies, however, offer policies which may cover such transports. If you have a policy beyond Medicare or Medicaid and wish to be transported to a doctor's office, please reach out to your insurer to see if they authorize it. They may contact us, and we'd be happy to arrange the transport.

Medicaid patients: Please note that Medevac will only schedule transports to doctors' offices which are located in areas served by Medevac Alabama. We will not travel outside of our service area due to cost restrictions.

Patients residing in skilled nursing facilities: It is the nursing facility's responsibility to get a preauthorization if they wish for the patient's insurance to be billed. In the event that the patient has Medicaid, Medevac will bill Medicaid for the service. If they patient is found to have Medicare or another insurance that does authorize such as service, the nursing facility will be financially liable.

Skilled nursing facilities under contract will receive the service at the reduced direct pay rate. 

Payment by contracted skilled nursing facility is required within 30 days.

Payment by non-contracted skill nursing facility has a more limited pay window to receive the reduced direct payment rate. It will be billed at the full rate, unless someone calls to obtain the reduced rate.

All reduced pricing is done at the direct payment price. No facility or individual gets a different price.

Dialysis patients are required to meet the same CMS guidelines as a patient going to a normal lower level of care (see "What if I need transportation home FAQ.") This means that:

1. The patient must be unable to get up from the bed without assistance; AND

2. The patient must be unable to ambulate without assistance; AND

3. The patient must be unable to sit in a chair or wheelchair.

OR the patient must have a condition that would cause an undue hazard to their health or safety to be transported by any other means. To give an example: a dementia patient whom does not remember that she cannot walk and whom has history of unbuckling seatbelts and attempting to stand would be such a case. It is important that we receive clear documentation of past incidents that led or could have led to injuries. 

Scheduling repetitive dialysis transport begins with documentation. A history and physical as well as any physical therapy notes are a good start. Additionally, we will reach out to the patient’s physician for their evaluation of the patient’s condition. If they are in agreement of the patient's condition, they will provide a CMN. The CMN will need to be re-certified every 60 days unless the patient’s condition improves and they no longer need Ambulance transport. Medicare and Medicaid, as well as most private insurances, will pay for these trips as long as they meet the very strict medical necessity conditions as laid out above. Same day service is not available for this service. It should be planned at hospital discharge or with a 48-72 hour lead time whenever possible. Medevac will work with home health or a hospital in setting up a bridge transport until the patient can be formally approved. This could be one or two day transport on a temporary certificate while the more formal one is prepared. Please contact our dispatch service who will put you in touch with a manager to arrange this service.

There are two ways in which you can obtain a copy of health information. 

Note: There is a $5.00 discovery fee, plus $1.00 per page. Medevac Inc. accepts all major credit cards, debit cards, money orders, as well as personal checks.

Please makes checks payable/remit to:

Medevac Alabama Inc.

PO BOX 1268

MOBILE AL 36633-1268

1. You can download and fill out a Medical Records Release Form, provide a copy of a valid government-issued photo ID or the proper proof of authority necessary to access the specified records, have it notarized, and fax it to (251) 800-7456.

2. You can stop by our office located at 61 Saint Joseph Street Suite 1401, Mobile AL, 36602 during business hours with a completed Medical Records Release Form and a valid government-issued photo ID.