Hospitals Must Use New PCS Form for Non-Emergency Ambulance Transfers to Avoid Fines from HFS

July 30, 2019

MEMORANDUM

This is a reminder that the updated Physician Certification Statement (PCS) form that a hospital must complete and provide to an ambulance provider, prior to transport of a non-emergency patient, must be implemented as part of each hospital’s discharge planning process.

The Illinois Department of Healthcare and Family Services (HFS) has indicated to IHA that a hospital’s failure to comply with completing the PCS will result in financial penalties. The PCS is an important document for ambulance providers, particularly when transporting Medicaid patients as many Medicaid managed care organizations and HFS will deny the ambulance provider’s claim without a completed PCS.

The new form developed by HFS, with input from IHA, pursuant to Public Act 100-0646, can be accessed here. To fill out and use this form, the preferred Internet browser is Internet Explorer. For other browsers, click here to see instructions.

Detailed information about new requirements for hospitals can be found in an August 2018 IHA memo. A recording of an IHA and HFS webinar on the new PCS can be accessed on the IHA Education page.