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Audit (A-01-08-00505)

08-25-2009
Payments for Ambulance Transportation Provided to Beneficiaries in Skilled Nursing Stays Covered Under Medicare Part A in Calendar Year 2006

Executive Summary

Ambulance suppliers did not always comply with consolidated billing requirements in calendar year (CY) 2006. Under the prospective payment system, some ambulance transportation provided by outside suppliers to skilled nursing facility (SNF) residents is included in the SNFs' Medicare Part A payments and is subject to consolidated billing. Of the 114 claims that we reviewed, 61 claims totaling $27,000 were incorrectly billed to Medicare Part B. As a result, the Medicare program paid twice for the ambulance transportation: once to the SNF under the Part A prospective payment system and again to the ambulance supplier under Part B.

Based on our sample results, we estimated that Medicare Part B carriers made a total of $12.7 million in potential overpayments to ambulance suppliers for transportation provided to beneficiaries in Part A SNF stays in CY 2006.

We recommended that CMS instruct its carriers to recover the $27,000 in overpayments for the 61 incorrectly billed claims that we identified and review the 97,799 claims that we did not review, which represent $12.7 million in potential Part B overpayments; provide additional guidance for suppliers and SNFs on its Web site and instruct its carriers and fiscal intermediaries to provide guidance to suppliers and SNFs to ensure compliance with consolidated billing requirements; and either establish additional edits in its Common Working File to prevent and detect Part B overpayments for ambulance transportation or instruct its carriers to develop a postpayment data match and recover any identified overpayments. CMS concurred with our recommendations.

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