Clarification on Ambulance Charges Under Consolidated Billing

LeadingAge New York reminds our members that ambulance transport for transfers between Skilled Nursing Facilities (SNFs) is an included service under Medicare Part A consolidated billing; therefore, the transferring facility is responsible for ambulance charges when the resident is in a Part A stay. Recent Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) analysis indicates that a high percentage of claims for such transfers have been inappropriately billed by ambulance providers under Part B. As a result, CMS is instituting new claims review procedure that will cause such inappropriate claims to reject. 

A complete reference on ambulance charges as they relate to residents in a Medicare Part A stay is available in MLN Matters article SE0433. CMS guidance on the new claims editing is available through their Transmittal 1326. Again, it is the facility from which the resident is being transferred that is responsible for the ambulance charge, and ambulance providers are being instructed to refer back to the transferring facility for payment of rejected Part B claims.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827