My mother fell from her wheelchair to the floor on her

face. The nursing facility sent her to the Emergency Room for x-rays, etc.

I just received a letter from the Ambulance Service stating that Medicare denied the claim.

Who is responsible for paying the costs?

Find Care & Housing
The SNF is not responsible for paying the ambulance fees imo.
They do, as a courtesy and routine procedure provide insurance information so that the ambulance company can bill the insurance properly.

When a claim is denied, someone may have used the wrong codes for treatment and diagnosis, and necessity for the ambulance. May require an explanation by treating physicians.

Either the SNF admin or the ER doctor (admin) can provide better information to the insurance company (medicare) to assist in an appeal. You can mail the insurance cards to the ambulance company. You can request an appeal, but the reasoning needs to come from the doctors. So call the billing office of the hospital so they can provide info to the ambulance company.

You will see the reason for the denial on the explanation of benefits. It may be that the charges are not covered at all. Read your EOB, call medicare to find out under what circumstances the charges are covered. Sometimes, the EOB will state if you did not know, you might not have to pay some charges.

If the charges are correct, negotiate with the ambulance company.
Helpful Answer (1)
Reply to Sendhelp

When my Dad was on his own, if he was taken by ambulance to the ER and admitted to the hospital Medicare paid for the trip. If he was not admitted my Dad had to pay.
Now he is on on Medicaid and he does not pay. He has no money at all. As long as he doesn’t go over the $2000 amount in his account, Medicaid pays.
Hope that helps.
Helpful Answer (1)
Reply to PrairieLake
Caregiverhelp11 Nov 30, 2018
I called the company and I was told Medicare denied it because they did not feel she needed the stretcher to get back to the nursing home. I told the Rep in billing that my Mom also has Medicaid and she said if Medicare denies the claim so will Medicaid. Doesn't make much sense to me.

I turned around and took the letter and discussed it with the Director of Nursing and she said the ambulance co. should bill through the Nursing Facility. I told her I was told it will need to be appealed and we will have to send in her Doctor's note that she did need to be transported by stretcher. So, at this point, I hope the DON will take care of it. We shall see.
When Mom was in independent living on Medicare with supplemental insurance, neither paid for her multiple trips to the ER. Medicare doesn’t cover ambulance transport. It was $300 a ride and we made and paid for many trips. Sigh. Now that she’s in NH and on Medicaid, Medicaid pays for transport, and the billing shouldn’t involve you. The only time I ever saw a bill, it was a mistake and I brought it to the NH admin and she said it was a mistake and gave it to accounting to submit to Medicaid.
Helpful Answer (0)
Reply to rocketjcat

The SNF pays if mom is there on her Medicare benefit (short term stay), if on Medicaid it may have been billed incorrectly from the ambulance company. Medicaid often pays the ambulance bill.
Medicare ambulance rules:
-If a resident is transferred to a snf from a hospital for admission to the snf
= the SNF pays the bill. The hospital discharge day is NOT a payment day for them, but it IS payment day number one for the SNF

If a resident is transferred to another SNF while on their Medicare benefit= the receiving SNF pays the bill since it is day one of payment for the receiving SNF, and NOT a payment day for the discharging SNF.

If a resident is on their Medicare benefit and goes out to the hospital emergently or for an acute your mom=the SNF either pays the bill for ambulance transport OR they are smart and know its excluded from what's known as consolidated billing, and therefore can be billed by the SNF to Medicare with the correct HCPC coding. The caveat here is the ambulance company doesn't talk to the snf. Thus I recommend you speak first to the ambulance company to explain it was an ACUTE transfer, then speak to the billing department at the SNF.

What muddies the waters is when a SNF resident on their Medicare benefit goes out to a doctors appt, and needs a true ambulance (BLS) to transport them for medical's either another scenario that's billable to Medicare (providing the doctor documented the medical necessity) OR it is the responsibility of the resident. Medicare will NOT pay for transport to an appointment in a wheelchair van (also provided by most ambulance companies).

Hope that helps! Dont pay that bill until you make a few calls! Those are expensive fee's!
Best of luck
Helpful Answer (2)
Reply to edenhomehc
Caregiverhelp11 Nov 26, 2018
Thank you. I will definitely make some calls.
Your mother is responsible, or rather Medicare should be. My mom, FIL, MIL, have all been in NH and every time they were transported to Dr or hospital Medicare always paid their required portion.
Helpful Answer (0)
Reply to mollymoose

No, she is. I would call the transport service if they coded the claim correctly. I thought Medicare paid for transport.
Helpful Answer (3)
Reply to JoAnn29

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