News, Skilled Nursing Facility

20% of Medicare ambulance claims have inappropriate billing for transport

CMS reports that in a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number of key problems, including:

  • Ambulance transports for beneficiaries who did not receive any Medicare services at the point of origin or destination
  • Transports to noncovered destinations
  • Excessive mileage reported on claims for urban transports
  • Medically unnecessary transports to partial hospitalization programs
  • Inappropriate transport service levels

In their new book, Medicare Guide for SNF Billing and Reimbursement, Janet Potter, CPA, MAS and Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC, reveal the question that all SNFs should ask themselves when determining whether Medicare will reimburse ambulance services for a beneficiary under consolidated billing (CB): Can this ambulance trip be deemed medically necessary? The answer to this question, say Potter and Rubertino, will be dependent on whether some other means of transportation (e.g., an ambulette or wheelchair van) could be used without endangering the beneficiary’s health.

Click here for HCPro’s quick reference tool that will help you determine when ambulance services should be billed by the ambulance provider under CB rules.