Friday, October 8, 2010

what are the destination covered under ambulance billing


Medicare covers ambulance transports (that meet all other program requirements for coverage) only to the following destinations:

• Hospital;
• Critical Access Hospital (CAH);
• Skilled Nursing Facility (SNF);
• Beneficiary’s home; or
• Dialysis facility for ESRD patient who requires dialysis; or
• A physician’s office is not a covered destination. However, under special circumstances an ambulance transport may temporarily stop at a physician’s office without affecting the coverage status of the transport.

As a general rule, only local transportation by ambulance is covered, and therefore, only mileage to the nearest appropriate facility equipped to treat the patient is covered. However, if two or more facilities that meet the destination requirements can treat the patient appropriately and the locality of each facility encompasses the place where the ambulance transportation of the patient began, then the full mileage to any one of the facilities to which the beneficiary is taken is covered. Because all duly licensed hospitals and SNFs are presumed to be appropriate sources of health care, only in exceptional situations where the ambulance transportation originates beyond the locality of the institution to which the beneficiary was transported, may full payment for mileage be considered. And then, only if the evidence clearly establishes that the destination institution was the nearest one with appropriate facilities under the particular circumstances. The institution to which a patient is transported need not be a participating institution but must meet at least the requirements of §1861(e) (1) or §1861(j) (1) of the Social Security Act.

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