Thursday, August 23, 2012

EMS Patient Care Report Writing | Documentation 101 | Part 4a - Nature of Dispatch - Emergency vs. Non-Emergency

Welcome to Part 4 in our continuing blog series “EMS Patient Care Reporting Writing/Documentation 101”.

    Part 1: EMS Patient Care Report Writing
    Part 2: Field Notes
    Part 3: Patient Demographics 
    Part 4a: Nature of Dispatch - Emergency vs. Non-Emergency

Dispatch sets the tone for billing…
Documenting the nature of dispatch of your call is vitally important for many reasons, but it’s especially important to support the billing of the level of service of the call.

Emergency versus non-emergency billing along with ALS versus BLS is determined in large part by how the call came to be dispatched, by what agency and the protocol used by the dispatcher to determine the level or priority the call is when dispatched.

In this week’s blog, we’ll tackle the issue of billing for Emergency versus Non-Emergency based on how the call is dispatched.

9-1-1 or the Equivalent…
During the negotiated rule-making process that unfolded several years ago, CMS developed the definition of an “emergency” ambulance call as one in which the ambulance was dispatched via a 9-1-1 center or an equivalent to a 9-1-1 center in areas where there is no 9-1-1 system and the ambulance takes the necessary steps to respond to the call as quickly as possible.

It is the responsibility of the patient care provider, the author of the Patient Care Report, to document how that call for ambulance treatment/transportation was taken.  Documenting the call as being taken by a Public Service Access Point (PSAP)/9-1-1 center thus allows the billing office to properly bill the call as an emergency assuming that the documentation also tells of a timely response to the call.

No 9-1-1 or 9-1-1 by-passed…
CMS does allow for an emergency level of billing even if the call originates via a 7-digit phone, or non-9-1-1 center origination.  In the event of such a scenario (for example, a skilled nursing facility that calls direct for emergency service to a contracted preferred ambulance provider), the documentation would note the call came through the non-9-1-1 call taking point but clearly document the life-threatening or immediate nature of the patient’s condition.

To support billing such a scenario as an emergency to Medicare and other insurances that follow Medicare guidelines, such a call that originates and is dispatched outside of the 9-1-1 system, requires that the ambulance company must maintain written proof that the call-intake point follows the exact same dispatch protocol as the nearest 9-1-1 center when determining the nature of the emergency.

While this documentation is not required to be included in the PCR, supporting documentation would need to be kept on file to support the emergency billing of a trip where the documentation could not substantiate dispatch via a 9-1-1 center.

How should it read?
Here is an example or two about how to document dispatch of a call originating in a 9-1-1 center…

“Medic 100 dispatched via Example County 9-1-1 for an alpha response, patient experiencing sub sternal chest pain with radiation down the left arm.  Ambulance 100 responded with on-call crew immediately upon dispatch.”

Lights and sirens…
“Ambulance 100 dispatched via Example County 9-1-1 for a BLS level response for a reported fall victim from a standing position with back pain.  An all-volunteer crew assembled at station and responded to the emergency without lights and sirens.”

Note in the second example, we mention for demonstration purposes that the ambulance responded minus lights and sirens.  Please note that the activation of lights and audible warning devices DOES NOT constitute the ability or non-ability to bill the call as an emergency in the eyes of CMS, by definition.

“While returning from a recent scheduled transport, ambulance 100 was contacted via radio by ABC Ambulance Company call-taker to respond to a call originating via the office phone line from XZY skilled nursing facility for a patient who has fallen from her bed and is experiencing severe hip pain with suspected hip fracture.  XYZ SNF requested an emergent response due to the nature of the injury and the patient’s pain level.  Ambulance 100 responded immediately upon receiving the call from the ambulance office.”

Of course, the balance of the Patient Care Report would document the nature of the injury to our example SNF patient who fell, including the treatment and how the patient was immobilized and moved given the suspected hip fracture. 

To accompany this PCR documentation of the incident; ABC Ambulance Company, if called upon in an audit to support billing this call as an emergency, would have records on file regarding the dispatch protocol followed by the 9-1-1 center closest to their geographical location.  That document would most likely include training provided to the non-emergency call-takers in their office on how to determine and properly dispatch when the request for ambulance service would be considered emergent in nature.

Now it’s up to you!
Congratulations!  You’ve read and conquered Part 4a of our ongoing blog series.  We hope the picture has begun to make sense for you as we piece this puzzle of effective Patient Care Report writing together in easily understandable and manageable parts.  Feel free to print these blog postings and share with your friends.  If you have any questions, be sure to e-mail your contact here at Enhanced.  My e-mail address is

Let me know what this series is doing to help you become a better Patient Care Report writer.  E-mail me with any suggestions you may have for topics we can cover as part of this series.

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