Physician Certification Statement

In January, 1999 the Health Care Financing Administration (HCFA) released a Final Rule, and on July 8, 1999 issued a Program Memorandum requiring a signed Physician Certification Statement (PCS) for non-emergent transports. This process was originally developed for Medicare but is now used by many different health insurance carriers (i.e., Medicaid, HMOs, etc.). Documentation must describe why thepatient could not have been treated at the original facility (i.e., hospital-to-hospital transfers). Equally important, having the appropriate signature is also a necessity.

Without the proper documentation, a denial will be received for that transport, with the need subsequently arising to bill the patient for the cost of our service. We feel that the patient should not be obligated to pay a bill that the health insurance carrier would normally have paid.

Providing the best possible quality in medical service is our main goal at Rural/Metro. The ability to achieve this goal depends on receiving the required documentation and being able to submit a claim to the health insurance in a timely manner. If a PCS is not received or completed correctly, it increases that time factor and work not only on the part of Rural/Metro, but the patient and the originating facility as well. By working together, everyone benefits from this.

When is a PCS required?

•  All non-emergency transports not originating from the patient's  residence
•  All transports from hospital to hospital (one-way trips)
•  All transports from hospital to nursing facility
•  All transports from hospital to residence
•  All non-emergency or direct admit transports from physician's  office, urgent care center, ambulatoryor primary care center to a  hospital