Wednesday, November 17, 2010

hospital to hospital transfer billing with admission tips - ambulance transport

Hospital to Hospital Transfer with Admission

Medically necessary transfers of a patient from one hospital to another for admission would be submitted to Medicare Part B, if a specialized service, level of care or bed is not available at the originating hospital. The receiving (admitting) hospital must be the closest hospital with the appropriate level of services.

Hospital bundling rules exclude payment to independent suppliers of ambulance services for beneficiaries in a hospital inpatient stay. Carriers exclude payment for ambulance services furnished to hospital inpatients within the admission and discharge dates unless billed directly by the hospital or furnished under arrangements. With the exception of the admission and discharge dates, all transportation provided to hospital inpatients must be bundled to the hospital. Ambulance services that are billed to the Carrier with a date of service that falls within the admission or discharge date on a hospital inpatient bill shall be rejected.

The supplier must report that the patient was discharged from the first facility and admitted to the second facility and the reason for the transfer to the second hospital in Item 19 of the CMS-1500, or Item 9, or 22 of the CMS 1491 claim form or the electronic equivalent.

Hospital to Hospital Transfer with Return

When a patient remains in inpatient status at one hospital and is transported to another hospital or facility for tests or specialized services and returns to the originating hospital, the services are covered by Medicare Part A.

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