CMS Pub. 100-04, ch. 3, § 10.5

Hospital bundling rules exclude payment to independent suppliers of ambulance services for

beneficiaries in a hospital inpatient stay. The Common Working File (CWF) performs reject

edits to incoming claims from independent suppliers of ambulance services. The CWF

searches paid claim history and compares the line item service date on an ambulance claim to

the admission and discharge dates on a hospital inpatient stay. The CWF rejects the line item

when the ambulance line item service date falls within the admission and discharge dates on

a hospital inpatient claim. Based on CWF rejects, the A/B MAC (B) must deny line items

for ambulance services billed by independent suppliers that should be bundled to the

hospital.

Upon receipt of a hospital inpatient claim, 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 an independent supplier. The CWF shall

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 the unsolicited response, the A/B MAC (B) shall adjust the ambulance

claim and recoup the payment.

Ambulance services with a date of service that is the same as the admission or discharge date

on an inpatient claim are separately payable and not subject to the bundling rules.

The CWF performs an additional edit before determining if the ambulance line item should

be rejected when the beneficiary is an inpatient of a long term care facility (LTCH), inpatient

psychiatric facility (IPF) or inpatient rehabilitation facility (IRF) and is transported via

ambulance to an acute care hospital to receive specialized services. The CWF edits the claim

for the presence of occurrence span code 74 (non-covered level of care) and the associated

occurrence span code from and through dates. The CWF bypasses the reject edit when the

ambulance line item service date falls within the occurrence span code 74 from and through

dates plus one day. In this case, the ambulance line item is separately payable. The CWF

rejects the ambulance line item when the service date falls outside the occurrence span code

74 from and through dates plus one day.