CMS Directs MACs to Reject Part B Ambulance Claims for SNF to SNF Transfers

On November 6, 2013, CMS issued Transmittal No. 1311 which instructed Medicare Administrative Contractors (“MACs”) to reject claims for SNF to SNF ambulance transfers that are billed separately under Part B. According to CMS, 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. Instead, the SNF discharging the beneficiary to another SNF is responsible for the transportation fees. As such, ambulance providers must seek payment from the transferring SNF.
CMS has advised that this transmittal constitutes technical direction, as opposed to a change to the MAC Statement of Work. This guidance is consistent with the rules set forth in the Medicare Claims Processing Manual, Chapter 15, SNF Billing, Section 30.2.2.

This issue was brought to the attention of CMS through the Recovery Audit Contractor (“RAC”) program, which is responsible for identifying and correcting improper payments in the Medicare program. A full copy of the transmittal is available here —> Transmittal No. 1311

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