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The following forms and documents are ones you may find useful. Feel free to use them as you see fit. If you have any forms or documentation which you feel would be appropriate for this space, please send us an e-mail. Also, please report any broken links by clicking on 'Contact Us' on the left side of this screen.   Thank You.

 
  Open file with Adobe Acrobat Reader Washington State Auditor's Systems Design Northwest Review - This document is used by all Washington State Auditors when conducting an audit of our ambulance billing clients. It contains explanations of the reports you receive from us, how they balance with each other and how they can be used to conduct your own internal audits. This document helps the auditor understand your procedures, as well as providing invaluable information to you regarding what the auditor will be looking for.
Open in Microsoft Word format Open file with Adobe Acrobat Reader Preparing for Ambulance Billing - This document can assist you as you start down the road to successful ambulance billing.
Open in Microsoft Word format Open file with Adobe Acrobat Reader Single Page Medicare Provider Application - This one page document will provide us with the necessary information to start filling out your Medicare provider application or update. The official application is 45 pages!
  Open file with Adobe Acrobat Reader Medicare Provider Application - Ambulance - Here's the actual Medicare Provider Enrollment Form - All 45 pages of it!
  Open file with Adobe Acrobat Reader AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (EFT) Form CMS-588 (08/06) - This document is mandatory for all new Medicare Providers as of September 1, 2007.
  Open file with Adobe Acrobat Reader 2006 Medicare Ambulance Claims Manual - Everything you ever wanted to know about how Medicare processes Ambulance claims, (and probably some things you don't want to know!) 133 Pages
Open in Microsoft Word format Open file with Adobe Acrobat Reader Levels of Service - This document describes the different Levels of Service (BLS, ALS I, SCT, etc) as defined by Medicare.
Open in Microsoft Word format Open file with Adobe Acrobat Reader Payments and Deposits - Brief description of the way we handle payments and a list of the banks we use.
Open in Microsoft Word format Open file with Adobe Acrobat Reader EMS Required Billing Items - This document defines the minimum data requirements we need in order to submit bills for the services you provide.
Open in Microsoft Word format Open file with Adobe Acrobat Reader Sample Signature Form - This sample form is a combination of the Assignment of Benefits Release, Responsibility of Payment and Acknowledgment of Receipt of Notice of Privacy Practices. It includes the Medicare required changes effective January 2008. Thanks to Page, Wolfberg & Wirth,LLC for making these sample available. Visit their site at PWWEMSLAW.com
Open in Microsoft Word format Open file with Adobe Acrobat Reader Sample Batch Control Log - When submitting transports to our office we require that a batch control log is included. This log becomes a vital part of the audit trail and ensures that all charges submitted are accounted for.
Open in Microsoft Word format Open file with Adobe Acrobat Reader Federal Poverty Guidelines for 2008 (excluding Alaska & Hawaii)
Open in Microsoft Word format Open file with Adobe Acrobat Reader Federal Poverty Guidelines for 2008 (Alaska only)
Open in Microsoft Word format Open file with Adobe Acrobat Reader Compensation for Ambulance Billing Agencies - A 'White Paper' comparing the
policy of compensating a billing agency based on a percentage of collections versus compensating based on the number of transports billed.
   

Medicare Proposed Urban / Rural / Super Rural designations - These tables indicate the designation by Zip Codes in Washington, Oregon and Alaska. If you are looking for this information for other states, please contact us and we will make it available.

            Washington                 Oregon                           Alaska

                                                        

    The following procedures come to you courtesy of Cowlitz 2 Fire & Rescue.
Open in Microsoft Word format Open file with Adobe Acrobat Reader Sample EMS Audit Procedures
Open in Microsoft Word format Open file with Adobe Acrobat Reader Sample Financial Assistance Policy
Open in Microsoft Word format Open file with Adobe Acrobat Reader Sample Transport Billing Procedures

Note: All .PDF files require the Adobe Acrobat Reader. It can be downloaded free at: