Eli's Hospice Insider

Published on Tue Mar 13, 2012 PDF

Time of admission is a determining factor, Medicare contractor explains.

Question: Is my hospice responsible for ambulance transport costs when the ambulance takes the patient from her home to an inpatient unit where she is admitted?

Answer: The answer to this question depends on when the admission occurred, according to a question-and-answer set from Home Health & Hospice Medicare Administrative Contractor Palmetto GBA. "If they are not a hospice patient at the time of the transfer from home to the hospice facility by ambulance, then the ambulance transport, as long as it meets the medical necessity guidelines for Medicare, would be billed directly to the Carrier by the ambulance provider," Palmetto explains in a Q&A for its Jan. 10 Ask the Contractor Teleconference. The ambulance transport "would be coverable in that manner and not be the responsibility of the hospice," Palmetto clarifies.

Look to the Centers for Medicare & Medicaid Services Medicare Benefit Policy Manual for further clarification, Palmetto suggests. "Ambulance transports to a patient's home which occur on the effective date of the hospice election (i.e., the date of admission), would occur prior to the initial assessment and therefore prior to the plan of care's development. As such, these transports are not the responsibility of the hospice. Medicare will pay for ambulance transports of hospice patients to their home, which occur on the effective date of hospice election, through the ambulance benefit rather than through the hospice benefit," the Manual says. "Ambulance transports of a hospice patient, which are related to the terminal diagnosis and which occur after the effective date of election, are the responsibility of the hospice."