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CMS-1403-FC
specified in §424.36 for satisfying the beneficiary
signature requirement.
In response to the assertion that the forms are
confusing, we reiterate that we did not create any new
forms for ambulance personnel or facility staff to sign.
Ambulance providers or suppliers may use whatever forms
they wish (such as the patient care trip report, etc.) for
capturing the signature and documentation requirements
specified in §424.36(b)(6). In response to the assertion
that spouses are reluctant to sign a form for fear that
they will be responsible for the ambulance transport bill,
signing of the claim form (or such other form used as a
proxy for the claim form) does not make a person
financially liable to pay the provider or supplier.
However, if a beneficiary or the beneficiary’s authorized
representative refuses to sign the claim form, the
ambulance company may bill the beneficiary directly for the
transport service. In addition, if the transport service
is deemed not medically necessary, and thus is not covered
by Medicare, the beneficiary may be held responsible for
payment (subject to the limitation of liability provisions
of section 1879 of the Act and our regulations at
§§411.404).
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