Wednesday, September 5, 2012

EMS Patient Care Report Writing | Documentation 101 | Part 4c - Dispatch - BLS Level of Service & Routine Transports

Welcome to Part 4 c 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
    Part 4b: Level of Service
    Part 4c: Dispatch - BLS Level of Service & Routine Transports

It’s the sixth installment but we’ve labeled it “Part 4c” because it’s the third and final part of a multi-post discussion on documenting the Nature of Dispatch. 

In this post we’ll be dealing with the importance of recording the dispatch in order to back up BLS level of service billed for the incident and we’ll conclude with a discussion on how to document dispatch for routine/non-emergency transports.

At what level is the call dispatched?
When the pager activates and you receive your dispatch, be sure to record the dispatch exactly as it’s given to you.  The level of service you are presented with when the emergency is relayed to you by the 9-1-1 center will go a long way in determining how the emergency is eventually billed.

If your 9-1-1 center uses a priority system, then be sure to record the initial priority as provided to you by the dispatcher.  Those priorities (example, Alpha, Bravo, Charlie, Delta or Priority 1, 2, etc.) have specific meaning and those definitions are documented at your dispatch center to label the determination of the call taker when making the decision on whether to send BLS or ALS ambulance responders to the emergency.

Medicare and almost all other insurance payers rely on this documentation to determine if your billing office has billed the call at the correct level, given the events of the incident as they unfold and as those events are documented to support the medical necessity of the call.  This documentation is key to setting the tone for the incident on the operations side and also for the later task of billing and collecting reimbursements dollars after the run is completed.

My center doesn’t prioritize…
Some 9-1-1 centers don’t necessarily prioritize between AL S and BLS.  No problem, except your service will have to rely on the condition of the patient upon arrival coupled with level of treatment required in order to determine the level of service that is billed.  This will mean that your service will not be able to bill the ALS Assessment-only call as there is no pre-determined level of dispatch provided to you upon being summoned for the call.

BLS
If your department is a Basic Life Support (BLS) service then your recording of the nature of dispatch serves two purposes, unlike the company that must justify ALS versus BLS and assuming that your company does not joint bill with an ALS provider.

The first purpose of documenting dispatch is to determine if the call if emergency versus non-emergency.  We discussed this previously, but for sake of our present discussion do not miss the importance of documenting if the call was provided to you via 9-1-1 or by a non-emergency call intake process.  How you received the call must be clearly documented coupled with documentation that your service either took the necessary steps to respond to the 9-1-1 as quickly as possible or, as in the routine call, note that you took no immediate steps to respond in emergent fashion.

Second, always be sure that you capture the patient’s condition and the reason you are being dispatched as the need for the ambulance, be it emergency or non-emergency, because this will tie to our discussion covering medical necessity documentation.

Scheduled and Unscheduled Routine/Non-Emergencies
One of the key items to call to your attention is the fact that a non-emergency/routine, scheduled or non-scheduled stays a non-emergency for billing purposes even if the incident becomes serious during transport.

We often field questions from clients who have responded in non-emergent fashion for a routine transport.  The crew arrives, loads the patient for the nice slow ride to the hospital and all of a sudden the patient’s condition changes to become life threatening.  The EMT yells to the driver to flip on the lights and change the destination to the emergency room because the patient’s condition is serious in nature. Or maybe this is a BLS crew and they call for an ALS team to interface en route.

Irregardless of the worsening condition of the patient and irregardless of the fact that an ALS provider interfaces, for billing purposes the trip continues to be billed as a non-emergency.  Just because the patient’s condition worsened beyond the initial scope of the intended purpose of the transport, which was routine or non-emergency, the call remains a non-emergency in that it began as a non-emergency.

Therefore it is important that you are clear when documenting these non-emergency trips as to where the call came from and the nature of the incident as it relates to the patient’s condition and subsequent transport.

Example…
Let’s review an example:

"Ambulance 100 dispatched by our non-emergency call-taker to American Nursing & Rehab for a BLS inter-facility transport to United States Hospital for a 81 year old comatose female patient in need of sterile environment debridement of Grade 4 decubitus ulcer located on the patient’s tail bone area.  Ambulance 100 responded at 2100 hours following the completion of a previous call and arrived on scene at 2145.  Patient was lifted to stretcher from bed using a two-person sheet lift method.  Once in the ambulance patient began to experience severe respiratory distress while we were transporting.  Lights and sirens were activated, patient was administered high-flow oxygen at 15 lpm via non-rebreather mask and transport destination was changed to the emergency room at United States Hospital instead of the wound care department.”

Although technically the patient’s condition became “emergent” in nature on the operations side of the equation, on the billing side because the trip began as a non-emergency it remains a non-emergency for billing.

Now it’s up to you!
Good job!  You’ve now made it through another week of the nature of dispatch discussion and you’ve successfully absorbed six weeks of our blog series.

That’s for taking the time to learn along with us. 

You’re well on your way to mastering the techniques necessary to author effective Patient Care Reports while helping to support your billing office, along the way.

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 chumphrey@enhancedms.com.

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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