Wednesday, April 18, 2018

CMS Clarifies SNF Consolidated Billing Instructions Related to Ambulance Transportation

Dan Ciolek

On April 13, the Centers for Medicare and Medicaid Services (CMS) posted a Medicare Learning Network (MLN) Matters article and an associated program manual transmittal instructions to Medicare Administrative Contractors (MACs) that provide clarification on coverage of an ambulance transport for a SNF resident in situations where consolidated billing does and does not apply. 

The revised manual sections are attachments to the transmittal. Make sure your billing staff are aware of these clarifications.   

Specifically, CMS is revising Chapter 10 of the Medicare Benefit Policy Manual, and Chapter 15 of the Medicare Claims Processing Manual to clarify that a medically necessary ambulance transport from an SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a resident (including the return trip) may be covered under Part B. 

This applies to beneficiaries who are in a SNF stay not covered by Part A, but who has Part B benefits. The revised instructions address potential SNF consolidated billing situations including:

  • The ambulance trip is to or from a hospital based or non-hospital based ESRD facility. 
  • The ambulance trip is for a SNF-to-SNF transport. Specifically, a transport between two SNFs (that is, a beneficiary’s same-day transfer from one SNF to another).

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