RSNAT Prior Authorization
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
The RSNAT Prior Authorization model allows ambulance suppliers to ensure their services comply with Medicare rules before rendering services and submitting claims. While voluntary, bypassing prior authorization subjects claims to prepayment medical review. The model aims to reduce appeals and Medicare spending while maintaining quality of care.
Innovation
Shifts the review of existing clinical documentation requirements to earlier in the process, before services are rendered and claims are submitted.
The Problem
Claims for non-emergent ambulance transports may be denied after services are rendered, leading to appeals and improper Medicare payments.
The Solution
Implementing a prior authorization process that requires necessary documentation earlier in the process, allowing providers to address claim issues before rendering services.
Expected Outcomes
Reduced RSNAT services and total Medicare spending while maintaining overall quality of, and access to, care.
Model Goals
- Ensure services comply with Medicare coverage, coding, and payment rules before services are rendered
- Reduce appeals for claims that may otherwise be denied
- Reduce expenditures while maintaining or improving access to and quality of care
Patient Eligibility
Medicare beneficiaries receiving repetitive, scheduled non-emergent ambulance transport.
- Must be a Medicare beneficiary
- Requires repetitive, scheduled non-emergent ambulance transport
Provider Eligibility
Ambulance suppliers providing repetitive, scheduled non-emergent transports.
- Must be an ambulance supplier
Care Categories
Ambulance Services
CMS Benchmarks & Thresholds
operational
See how this model fits your organization
Answer three quick questions about your facility and get matched to the VBC models that fit your profile — with benchmark context from organizations like yours.
Start Assessment