Tuesday, December 28, 2010

Skilled Nursing Facility Transports ambulance biling

Skilled Nursing Facility Transports

The following ambulance services are included in consolidated billing. Claims should be submitted by the SNF to Medicare Part A.

• For beneficiaries in a Part A covered stay, a medically necessary ambulance transport from one SNF to another SNF.
• Ambulance transports for beneficiaries in a Part A covered stay, to or from a diagnostic or therapeutic site other than a physicians office or hospital (i.e. IDTF, cancer treatment center, radiation treatment center, wound care center) are to be part of SNF Consolidated billing.
• If the patient is traveling from the SNF to a doctor’s office the trip would be the responsibility of the SNF, as would the return trip.

• Medically necessary ambulance transports that are furnished during the course of a covered Part A stay are included in consolidated billing with the exception of specific excluded services.
Listed below are a number of specific circumstances under which a beneficiary may receive ambulance services when resident status has ended. These ambulance trips are excluded from consolidated billing, and claims should be submitted by the ambulance supplier to the carrier (Part B).

• The ambulance trip is to the SNF for admission
• A medically necessary round trip to a Medicare participating hospital or Critical Access Hospital for the specific purpose of receiving emergency or other excluded services.
• Medically necessary ambulance trips after a formal discharge or other departure from the SNF, unless the beneficiary is readmitted or returns to that or another SNF before midnight of the same day.

• An ambulance trip for the purpose of receiving dialysis and dialysis-related services that are excluded from consolidated billing.
• A trip for an inpatient admission to a Medicare participation hospital or Critical Access hospital.
• After discharge from the SNF, a medically necessary trip to the beneficiary’s home where the beneficiary will receive services from a Medicare participating home health agency under a plan of care.

Certain services are excluded from consolidated billing only when furnished on an outpatient basis by a hospital or a critical access hospital. Ambulance transportation for the following services is excluded and should be billed to Part B:

• Cardiac catheterization services;
• Computerized axial tomography scans;
• Magnetic resonance imaging;
• Ambulatory surgery involving the use of an operating room (the ambulatory surgical exclusion includes the insertion of percutaneous esophageal gastrostomy (PEG) tubes in a gastrointestinal or endoscopy suite);
• Emergency services;
• Angiography; and
• Lymphatic and venous procedures
• Radiology therapy
• Removal, replacement or insertion of a PEG tube

Services for those patients requiring an ambulance that have exhausted the Medicare Part A skilled nursing benefit, who are residents of a SNF, but no longer in a Part A stay, would be reported to the carrier for Part B reimbursement. All the standard coverage and billing requirements apply to these transports (medically necessary, closest facility etc).

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