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Skilled nursing facility ambulance transport monitoring

John Falcetano ( is Director Corporate Compliance at Brooks Health System in Jacksonville, FL.

A critical element of any effective compliance program is monitoring. As a service to our members, each month this column focuses on potential monitors for specific business lines.

One area of concern that requires monitoring is ambulance transports for Medicare beneficiaries who are residents in a skilled nursing facility (SNF). Ambulance transports of SNF residents are included in Medicare Part A payments to SNFs as part of consolidated billing requirements, unless it meets an exception. SNFs services are paid through the Medicare prospective payment system (PPS). Under the PPS, Medicare Part A pays SNFs through per diem, prospective, case-mix-adjusted payment rates that cover virtually all of the costs of furnishing services to Medicare beneficiaries.

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