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Sample Contract beteen SNF/Ambulance Provider for Medicare Patients in Part A Stay

Two documents are listed below: (1) a sample contract, followed by (2) a letter from an SNF to an EMS provider proposing certain contract criteria.

(1) Sample Contract
According to the new Prospective Payment System (PPS) and Consolidated Billing, SNFs will bill certain transports for Medicare patients, and ambulance companies will bill SNFs under contract.  We were asked by an Alabama EMS provider to assist in a sample contract for a Skilled Nursing Facility for whom the provider was transporting Medicare patients.The EMS provider had met with the SNF and agreed upon some ground rules, and we came up with a sample contract based on this agreement.  There can be a wide variety of contracts, and hopefully the contract listed below will be a rough guide for you.

SNF Contract for Ambulance transports covered under PPS/Consolidated Billing for Part A Stay Medicare patients.
Medicare patients admitted to SNFs are covered under Part A Stay for the first 100 days, and this may not necessarily be the only times these patients are Part A Stay, but for simplicity, let us leave it at that. According to Medicare, there has been a postponement past January 1999 of the requirement for SNFs to go on Consolidated billing, but when SNFs choose to do so, then ambulance companies and other suppliers are required to do so at the same time.

This contract addresses three issues concerning ambulance transports for Part A Stay Medicare patients: Œ Ambulance transports covered under PPS/Consolidated billing;  Amounts Medicare Allows and pays SNFs; and Ž Contract amounts that Xxxxxxx EMS.

It is our understanding that SNFs are reimbursed for ambulance transports per the state prevailing fee screen. SNFs have a certain "Medicare Allowed" amount per this screen, and are reimbursed 80% of this allowed amount

ΠAmbulance transports covered under PPS/Consolidated billing

SNFs ARE NOT responsible for the following ambulance transports (EMS provider bills Medicare directly):

• Initial transport to the SNF for admission

• Final transport from the SNF following discharge

• Transport from the SNF when the patient is not returned to the SNF before midnight

• Emergency transports

 

SNFs ARE responsible for the following ambulance transports (EMS Provider bills SNF; SNF bills Medicare):

• Round trips to the hospital that are required for a resident receiving services that are within the normal scope of SNF care plan

• Round trips for a resident who is discharged, taken home by ambulance and then returned before midnight

• The discharging SNF is responsible for the transport transferring a resident from one SNF to another (unless the discharging SNF was not an appropriate facility and the admitting institution was the nearest one with appropriate facilities)

• Round trips to all other facilities for services done on an outpatient basis (for example, dialysis clinics, physician offices, etc.)

 Amounts Medicare Allows and pays SNFs (Note: these are Alabama rates)

HCPCS Code	Description	Medicare Allowed	SNF Payment (80%xAllowed)	Xxxxx EMS Chgs SNF 90%xSNF Pmt	SNF Allowed Net	CoPay/ Coins 20%xAllowed	SNF Total
A0360	BLS Base	101.25	81.00	72.90	8.10	21.21	29.31
A0360	BLS Base Return	101.25	81.00	72.90	8.10	21.21	29.31
A0422	Oxygen	25.88	20.70	18.63	2.07	5.18	7.25
A0422	Oxygen return	25.88	20.70	18.63	2.07	5.18	7.25
A0380	Per Loaded Mile	2.59	2.07	1.86	0.21	0.52	0.73
A0380	Miles Return	2.59	2.07	1.86	0.21	0.52	0.73
A0382	Disp Supplies	27.79	22.23	20.00	2.23	5.56	7.79

Ž Contract amounts that Xxxxx EMS Ambulance Service bills the SNFs

The table above contains all of the amounts involved in the proposed contract. It is recognized that there is some cost to the SNF for the involvement in billing for ambulance transports, and thus the total reimbursements should be more than charged by the ambulance company. To explain the table, A0360 is the Medicare HCPCS code for BLS Base Rate non-emergency. The Alabama state prevailing is $101.25, and that is the Medicare Allowed amount. Medicare pays 80% of this amount ($81.00), and the remaining 20% ($21.21) can be collected from either the patient (copay) or supplementary insurance (coinsurance). It is proposed to charge the SNF 90% of the Medicare payment of $81.00 ($72.90) for a guaranteed net to the SNF of $8.10, plus the possibility of the SNF collecting the $21.21 copay/coinsurance for a total SNF revenue of $29.31 for each base rate. A typical round trip would be two base rates, four miles, and one disposable supply for a total revenue to the SNF of $67.87 per ambulance transport.

(2) Letter from an SNF to an EMS provider proposing certain contract criteria.

ED NOTE: This letter was submitted by an SNF to an Ambulance Provider, and is listed here in its entirety, with neither claims to its conformity to HCFA requirements nor to its accuracy -- only for your information

1/15/99
AMBULANCE SERVICES SUMMARY
1. Effective with PPS effective date for Medicare Part A patients only.

2. Revenue code to be used when posting revenue (not assigned yet)
     Revenue code 540 is used on UB92.
     Expense account # is (will be assigned later)

3. The charges will be entered on the Third Party Maintenance screen by the bookkeeping department.

4. SNFs ARE NOT responsible for the following ambulance trips:

   a. trip is to the hospital to receive one of these services:
      1. Cardiac catheterization
      2. Computerized axial tomography scans (CT scans)
      3. Magnetic resonance imaging (MRIs)
      4. Ambulatory surgery involving use of an operating room
      5. Emergency services
      6. Radiation therapy
      7. Angiography procedures
      8. Lymphatic and venous procedures

   b. initial trip from a hospital to an SNF to be admitted as a resident

   c. trip from an SNF to a hospital to be admitted as an inpatient

   d. trip from an SNF to a home (or other domicillary setting) with no return before midnight)

5. SNFs ARE responsible for the following ambulance trips:

   a. trip to and from the hospital that is required for a resident receiving services that are within the normal scope of SNF care plan.

   b. round trip for a resident who is discharged, taken home by ambulance and then returns by ambulance before midnight.

   c. the discharging SNF is responsible for the trip transferring a resident from one SNF to another (unless the discharging SNF was not an appropriate facility and the admitting institution was the nearest one with appropriate facilities).

   d. trips to and from all other entities for services done on an outpatient basis (for example, dialysis clinics, physician offices, etc.).