Friday, October 5, 2012

EMS Patient Care Report Writing | Documentation 101 | Part 7 - Mileage and Odometer Readings

Welcome to Part 7 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
    Part 5: Arrived on Scene and Chief Complaint
    Part 6: Signs and Symptoms
    Part 7: Mileage and Odometer Readings

If you’ve been with us from the start you’re actually reading the ninth installment of our blog feature covering effective Patient Care Report writing.

This week, we’ll be focusing on the importance of recording and including odometer readings from the ambulance in order to determine the loaded mileage to be billed for the call.

Loaded miles
With only one exception, the mileage we record for our EMS incidents is defined as “loaded miles.”  Loaded is defined as the total miles recorded between the point of pick-up of the patient to the drop-off destination, typically a hospital or other facility.

The PA Exception
Pennsylvania ambulance providers have one exception to the loaded miles rule and that’s for Medical Assistance/Medicaid. Pennsylvania Medicaid pays for mileage that totals from the round trip of the incident, less the first twenty miles.

This means that in Pennsylvania, when transporting and ultimately submitting a claim to PA Medical Assistance that we would be reporting the total mileage from the point the ambulance leaves the garage until the point when the ambulance returns to the garage, less twenty miles. This implies that if the total round trip mileage is less than twenty miles, no mileage is paid for that incident’s claim.

Medicare- to the nearest tenth
Fee-for-service Medicare claims are required to be reported using a loaded mileage total to the nearest tenth. This is a change that was put in place last year when the Centers for Medicare and Medicaid Services (CMS) changed the payment methodology.

Prior to 2011, a transport that exceeded a whole number of miles by even one-tenth of a mile was paid to the next full whole number mileage total. CMS changed that rule in 2011 requiring all ambulance claims to be reported and subsequently payment made in fractions of miles. For example, if the loaded mileage total is found to be 2.1 miles then Medicare will pay the claims at 2.1 times the Medicare National Ambulance Fee Schedule approved amount that applies (either urban or rural).

Odometer Readings a Must!
It is extremely important that the ambulance crew record the actual odometer readings for each point of the transport. Obviously, if the crew is uncertain of the type of insurance it will be important to record all points of the transport in Pennsylvania (Start, On Scene, At Facility, In Quarters/Run Conclusion). The only reliable method of backing-up the mileage reported on the claim is to record the actual odometer readings at each point of the trip.

The use of trip odometer readings is acceptable however it is best to actually record the full odometer reading whenever possible.

What if I forget?
As a last resort a verifiable online map program can be used to determine the mileage. However, we suggest this only be used as a last resort and only for those times that you absolutely forget. If using an online program to determine the mileage traveled, be sure to make a printout of the information obtained from the Internet-based mapping program and include that information with your Patient Care Report for the billing office to review and record.

GPS Devices
The use of GPS devices is acceptable; however we suggest that it be a device with the ability for the results to be recorded either digitally or via printout. Technology is changing almost daily and new devices are being developed to include live tracking and CAD interface modules.

Consistency for Repeat Transports
Always be sure that the shortest routes to facilities are used for each transport. Repeat transports for patients between Facility A and Facility B should not find recorded mileage distances that differ by wide margins. Quite possibly a tenth of a mile difference here and there is acceptable, however if today the transport of a patient between Facility A and Facility B is recorded as  5.1 miles, yet that same transport is recorded tomorrow as 8.6 miles, then something doesn’t quite add up. It’s those differences that will be noted as unusual and quite possibly target the ambulance company for audit by the Medicare Administrative Carrier, Medical Assistance and/or Commercial Insurance Companies.

Coordination using the same and shortest distance transport routes each and every time is an important course of action to follow.

However, what if the bridge is out or there is a huge traffic jam today that causes the crew to take an unusual detour resulting in additional miles for the transport? No problem, simply be sure that you make note of the detour when documenting the trip in the Patient Care Report. Unusual events can happen and as long as they are adequately explained in the PCR, there should be no compliance issue.

Conventional Rounding for Commercial and Patient Pay Billing
Odometer readings are equally important for Commercial and Patient Pay billing scenarios. In those cases, the ambulance billing office will use conventional rounding rules to report the loaded mileage for the trip unless provider billing manuals for a specific insurance payer dictates otherwise.

Therefore if the ambulance crew reports the loaded mileage distance to be 6.6 miles the trip will be billed as rounded to the nearest whole mile amount of 7 miles. Should the ambulance crew report 6.4 miles then the trip would be billed at 6 miles. Mileage totals of 0.1 to 0.4 miles will be rounded down to the nearest whole mile factor and mileage totals of 0.5 to 0.9 will be rounded up to the nearest whole mile number.

Another Important Element of the PCR
There you have it.  Another piece to the PCR puzzle has been provided to you. Over the past nine weeks we have been dissecting important elements that must be recorded as part of the PCR you write and turn into the billing office for billing of the claim for payment.

Thanks for following our blog. 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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