CWF Editing of Ambulance Claims for Inpatients

30.1.4 - CWF Editing of Ambulance Claims for Inpatients (Rev. 1696; Issued: 03-06-09; Effective/Implementation Date: 04-06-09) Hospital bundling rules exclude payment to independent suppliers of ambulance services for beneficiaries in a hospital inpatient stay (see IOM Pub. 100-04, Medicare Claims Processing, chapter 3 - Inpatient Hospital Billing, Section 10.4 - Payment of Nonphysician Services for Inpatients). CWF performs reject edits to incoming claims from suppliers of ambulance services. Upon receipt of a hospital inpatient claim at the CWF, CWF searches paid claim history and compares the period between the hospital inpatient admission and discharge dates to the line item service date on an ambulance claim billed by a supplier. The CWF will generate an unsolicited response when the line item service date falls within the admission and discharge dates of the hospital inpatient claim. Upon receipt of an unsolicited response, the A/B MAC (B) will adjust the ambulance claim and recoup the payment. Ambulance services with a date of service that are the same as an admission or discharge date on an inpatient claim are separately payable and not subject to the bundling rules.