Medicare Part B Payments for Ambulance Services Rendered to Beneficiaries During Inpatient Stays: 2001 Through 2003

EXECUTIVE SUMMARY:

This audit follows up on a prior review of nonphysician services provided during stays at inpatient prospective payment system (PPS) hospitals in calendar years 1998-2000 (A-01-01-00502, issued August 6, 2002).

The objective of our audit was to determine whether Medicare carriers made inappropriate payments for ambulance services provided to PPS hospital inpatients.  During calendar years 2001-2003, carriers inappropriately made Part B payments for 203,377 ambulance services provided to PPS hospital inpatients.  As a result, Medicare potentially overpaid $21.7 million for ambulance services by paying twice:  once to the hospital as part of the diagnosis-related group payment and again to the ambulance supplier under Part B.  Furthermore, the Medicaid program, beneficiaries, or supplemental insurers could have paid more than $6.2 million in coinsurance and deductibles related to these potential overpayments. 

We recommended that CMS:  (1) instruct the Medicare carriers to recover the $21.7 million in potential overpayments, (2) establish payment controls to detect and prevent separate payments for Part B ambulance services provided to beneficiaries during inpatient stays or develop postpayment review procedures to identify suppliers that submit and receive payments for inappropriate billings, and (3) alert the carriers to the most common types of payment errors and help them to educate ambulance suppliers about such improper billings.  CMS concurred with our recommendations.

---