Monday, May 30, 2016

Payment for Intra-facility Ambulance Transport

Medically necessary transports between provider sites will be reimbursed for the following conditions:

1. The two locations have different NPIs


2. The campuses are in two different locations (a campus is defined as areas located within 250 yards of main buildings) AND the patient is not inpatient status at the time of transport.

This policy does not supersede the policy on ambulance transports during inpatient stay which states:

If a patient must be transported by ambulance to another facility for unavailable services (i.e. diagnostic tests or surgical procedures) during an acute hospital inpatient stay, the ambulance provider cannot separately bill this transport. The ambulance provider must have an arrangement with the hospital for appropriate billing and payment. The charges for the ambulance transport are considered part of the inpatient stay and are reimbursed based on the DRG.

Examples of transports eligible for payment:

• A suicidal patient is seen in a provider’s emergency room (ER) and is transported by ambulance for admission to the same provider’s psych unit located outside of the campus containing the ER or to the psych unit that has a different NPI.

• A patient seen in the clinic for physical therapy services has a stroke and requires transport to the hospital for additional care.

• A patient having a surgical procedure done in the Ambulatory Surgery Center (ASC) has a severe hemorrhage and requires transport to the hospital for additional care.

Examples of transports not eligible for separate payment:

• A patient has a procedure performed in a facility’s ASC and is transported to the same facility’s outpatient hospital for additional non-emergent care/routine post-op recovery.

• A patient who is inpatient at a hospital or unit of a hospital needs an MRI and is transported to a different location where the MRI machine is located, then transported back to the original location.

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