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Overpayments resulting from improper claims for ambulance services

On November 6, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 1311, which offered guidance on the contractor claim data, identified by suppliers, which were billing ambulance claims for SNF to SNF transfer separately under Part B. This was resulting in overpayments.

As a result of overpayment for a transport between two SNFs when a beneficiary is in a Part A covered SNF stay, CMS will implement an Informational Unsolicited Response (IUR) and Reject for an ambulance claim when suppliers are billing ambulance claims for SNF to SNF transfer separately under Part B.

The Centers for Medicare & Medicaid Services (CMS) policy indicates: “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 SNF discharging the beneficiary to another SNF is financially responsible for the transportation fees and the ambulance providers should seek payment from the transferring SNF.

To read more, click here for the full memo.