Ambulance - Skilled Nursing Facility Consolidated Billing
Under Medicare's Skilled Nursing Facility (SNF) Consolidated Billing rules, the SNF is generally responsible for billing and payment of most services provided to a resident during a covered Medicare Part A SNF stay. Ambulance services are treated differently depending on the purpose of the transport. Only a limited number of services are excluded from consolidated billing and are therefore reimbursed separately.
Medicare contractors are responsible for assuring that payment is made only for ambulance services that meet established coverage criteria. In most cases, ambulance trips are excluded from consolidated billing when resident is being discharged.
Common scenarios/responsible party
| Type of Trip | Who is the Responsible Party |
|---|---|
| Initial admission to SNF | Excluded from consolidated billing. Can be billed to Medicare |
| SNF to SNF; beneficiary not in Part A stay | Excluded from consolidated billing. Can be billed to Medicare |
| Final discharge from SNF to home (no return same day) | Excluded from consolidated billing. Can be billed to Medicare |
| To home, return to same SNF same day, before midnight | Bill SNF |
| To another SNF before midnight | Bill discharging SNF |
| Inpatient hospital admission from SNF | Excluded from consolidated billing. Can be billed to Medicare |
| Home to receive services from a home health agency under a plan of care | Excluded from consolidated billing. Can be billed to Medicare |
|
To outpatient hospital for:
|
Excluded from consolidated billing. Can be billed to Medicare |
| Transport to/from dialysis | Excluded from consolidated. Can be billed to Medicare. |
| Transported for therapy services | Bill SNF |
| Transport to physician's office during a SNF Part A stay | Bill SNF |
| Transport to/from diagnostic or therapeutic site | Bill SNF |
Reference