This PPS Billing Quick Reference guide is provided by Cooperative Health Partners (CHP).
For more information, please leave your contact information and we will be happy to contact you to discuss any questions you may have.


 


 

 

FOR AMBULANCE SERVICES DURING THE PPS PERIOD

 

                            Ambulance Bills:

Type of trip                     

Part B Carrier

Facility

1. Initial Admission to SNF

X

 

2. Final Discharge from SNF:

 

 

2a. To home (no return same day)

X

 

2b. To home (return to same SNF same day)

 

X

2c. To another SNF, including for elevated level of care

 

   X*

3. Inpatient Hospital Admission:

 

 

3a. To hospital from SNF admission

X

 

3b. To SNF from hospital (i.e. discharge)

X

 

4. Trip to BeneficiaryÕs Home for Medicare Home Health Services

X

 

5. Transports to/from dialysis

X

 

6. Trip to Hospital for Outpatient Services:

 

 

6a. Transports for all services other than those listed in 6b below, must be billed to the facility, including:

  • Physical, Occupational, Speech Therapy
  • Diagnostic Tests or Services Routinely Provided by SNFs
  • Evaluation or Treatment Services (other than a hospital admission or one of the outpatient services listed in 6b below)

 

 

X

 

 

 

 

 

 

 

6b. The following trips to a hospital for outpatient services should be billed to Part B, if for:

  • Emergency
  • Cardiac Catherization
  • CT Scans
  • MRI
  • Ambulatory Surgery** Involving Operating Room (this includes PEG tube procedures, even if performed in a hospital GI suite or endoscopy suite)
  • Angiography
  • Lymphatic and venous procedure
  • Radiation therapy

NOTE: ALL SERVICES IN 6B MUST BE PERFORMED AT THE HOSPITAL (NOT A FREE-STANDING FACILITY) FOR YOU TO BILL YOUR CARRIER. IF NOT PERFORMED AT THE HOSPITAL, THE SNF/SWING BED FACILITY IS RESPONSIBLE

X

 

7. Transports to any Medicare Provider for chemotherapy, chemotherapy administration, radioisotopes, customized prosthetic devices, barium swallow, hyperbaric oxygen, transfusion

 

X

8. Transports to a physicianÕs office (only during a Part A stay)

 

X

* Discharge Facility is responsible

** Minor procedures that can safely be performed by SNF are not billable to Part B. An updated list of these minor procedures, arranged by HCPCS procedure code, can be found at:

http://www.cms.hhs.gov/SNFConsolidatedBiling/80_2006_FI_Update.asp

REMINDER, IF THE SERVICES ARE NOT SPECIFICALLY LISTED ABOVE AS BILLABLE TO THE CARRIER, IT IS THE RESPONSIBILITY OF THE FACILITY.