User Guide for the Cost Data Collection Instrument

Vehicle Costs  As stated earlier, CMS considers ground ambulances to include both land and water.  Additionally, CMS wants to  learn about non‐ambulance vehicles used in relation to your ground ambulance operation.  In regard to the  table below:   You will need to include all ground ambulances regardless whether the ambulance transported patients  or whether you billed for transports made by this ambulance.     You will need to track the total number of ambulance and non‐ambulance miles.  For land ambulance,  this includes billed and unbilled.  For water ambulance, this includes any miles for any reason.  Likewise,  for non‐ambulance, this includes any miles for any reason. 

Owned 

Question 

Ambulance 1 Ambulance 2 

Etc. 

Was it used to transport patients?  Was it donated?  If not donated, what is its annual depreciated value?   Was it remounted?  If yes to remounted, what was the cost?  Total miles (billed) during collection period  Total miles (unbilled) during collection period 

Leased 

Was it used to transport patients?  What was total lease cost? 

Ground Ambulance 

Total miles (billed) during collection period  Total miles (unbilled) during collection period 

Owned 

Question 

NAV 1 

NAV 2 

Etc. 

What type of vehicle is this?  Options will include  fire truck, land rescue vehicle, water rescue vehicle,  and vehicle that responds to emergencies but is not  designed to transport patients  Was this vehicle used to respond to ambulance calls  or support ground ambulance operations?  Was this vehicle donated?  If not donated, what is its annual depreciated value?   Total miles travelled during collection period  Leased  What type of vehicle is this?  Options will include  fire truck, land rescue vehicle, water rescue vehicle,  and vehicle that responds to emergencies but is not  designed to transport patients  What was total lease cost? 

Non‐Ambulance Vehicles (NAV) 

*For agencies that have a parent organization, you will need to track and allocate to your NPI the portion of  other vehicle costs incurred at the level of the parent organization, based on your organizational approach for  allocating costs to specific NPIs.

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