CMS clarifies Medicare payment rules for SNF to SNF ambulance transportation

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A skilled nursing facility discharging a Medicare Part A resident to another SNF is responsible for ambulance transportation fees, and no separate Part B claim should be made for that service, the Centers for Medicare & Medicaid stated in a recent memorandum.

Recovery audit contractors have determined, based on claims data, that some suppliers are inappropriately billing Medicare Part B for SNF to SNF transports, according to the CMS memo.

“Ambulance transportation and related ambulance services for residents in a Part A stay are included in the SNF PPS rate and may not be billed as Part B services by the supplier,” the Nov. 6 transmittal states.

CMS instructed Medicare administrative contractors to deny these Part B claims. Click here to access the memo.

The memo was issued one day before the nation's second-largest ambulance services provider agreed to settle a Medicare lawsuit for $8 million. The whistleblower charges related to a swapping arrangement. These typically involve SNFs sending Medicare Part B residents to particular companies. In exchange, these companies offer the SNF price breaks on services provided to less lucrative Part A residents.