Friday, July 19, 2013

Pediatric Patient Pitfalls

That Lump in your Throat
We don’t know about you, but each and every time we’re dispatched to a pediatric emergency, there’s just this lump that forms in the throat. Somehow, the gravity of having a young life with a long future ahead of them resting in our hands tends to make us swallow hard and sweat a little while responding to the call.

Not only are these patients challenging but they aren't the patient population that we’re used to working with on a daily basis. They crash easy, they’re hard to assess because they can’t typically verbalize or express what they’re feeling (or not feeling) and they are typically petrified at the sight of an ambulance with all those scary “gadgets”.

So while you’re trying to assess their lung sounds, they’re screaming in your stethoscope and blowing your ear drums into the middle of your brain.

Been there, done that?

In the field and in the office…
Not only are these young people a challenge for you in the field, but some very unique issues surround these patients later on in the billing office, too.

Pediatric and minor patients present challenges that often aren't easily overcome unless everyone cooperates to leap the hurdles.

Mission Critical!
Of course, these patients are minors by definition. Therefore, they are not legally responsible for anything like your typical adult patients.

Given this fact, the first important step toward successful billing of these scenarios is collecting the name, address, telephone number and any other pertinent information such as insurance coverage of the person that is responsible for the child you are caring for. Typically, this person will be a parent or legal guardian, who may or may not be a grandparent, aunt, uncle or maybe even court appointed such as foster care providers.

Bottom line, a responsible adult’s information must accompany any pediatric patient as part of the filing of the Patient Care Report (PCR).

This is mission critical!

Insurance
Much like the responsible party or guarantor is an adult, typically the adult in the equation is also the insured and coverage for little junior is under the adult’s umbrella policy. However, keep in mind there may be more than one guardian, especially in the situations where Mom and Dad are no longer living under the same roof.

So Mom may be the guardian of record, but Dad may be providing the insurance under a custody arrangement. This is where things can get a little sticky when collecting insurance information in the field. It will do your billing office no good to receive Mom’s insurance information when the child is covered under Dad’s policy.

You can easily jump this hurdle by asking some basic questions to make sure you have collected the correct information.

In the case of Medical Assistance or Medicaid coverage, it may be that the child has his/her own coverage under programs like CHIP or other State-administered plans. We've also seen children that even have Medicare coverage for things like chronic long-term disabling diseases.

In these cases, sometimes it’s very helpful to your billing office if you actually copy the front and the back of insurance cards as there often will be vital coverage information that is unique to children printed right there on the card.

Signatures
Because authorization signatures are so important, keep in mind that having a minor sign (of course, you wouldn't ask a 3-year-old to sign, but you may not think anything about having a 16-year-old sign) the signature authorization form is a waste of time.

Discounting the fact that you may encounter an emancipated minor, it’s useless to ask anyone south of legal age (typically 18 years of age) to sign a legal document in an attempt to attach responsibility for the legal ramifications of signing said document.

Therefore, as a street provider, you will need to obtain a signature from the responsible person in order to “make it stick.” Of course, those people aren't always going to be present and we get that….not much you can do about that, we’ll concede.

Follow-up and Collections
Finally, be sure that everyone is alerted to the fact that the patient is a minor child, especially your billing office. There’s nothing more embarrassing than calling to attempt to collect on an unpaid bill, only to learn that the person you are attempting to call is 6-years-old and has no clue what the word invoice even means, let alone accept responsibility to pay it.

Be careful not to let these billing scenarios slip through the cracks. Parents don’t respond well when they believe their children are being harassed. This especially relates to scenarios where, while not necessarily pediatric patients, below-legal-age teenagers and students can be misidentified as responsible parties and collection efforts are made directly to the minor because someone wasn't careful about alerting everyone in the loop.

Again, correctly identifying and documenting the responsible adult counterpart is critical to avoiding this pitfall. Certainly it’s important that your billing office or outsourcing contractor can clearly identify minors via specially flagged reports and/or reputable billing software that enables you to view the age, date of birth and special flags that you can program to alert you as you are interacting with patients and their “families.”

Also remember that even some young people approaching or over the age of 21-years-of-age could technically still be covered, as a full-time student, under a parent’s or guardian’s insurance policy. This can also be true of auto and liability insurance, as well when Mom or Dad technically owns the vehicle.

Process and Training
The key to successful data collection and the subsequent billing of pediatric patient scenarios is to have a process in place for adequate staff training so your crews understand what they need to obtain for the billing office.

We suggest that you do a small in-service training to cover the pitfalls as we've outlined above in order to provide your crew members with your expectations for these trips and the accompanying paperwork. Maybe you could combine your in-service time with pediatric care training and make a “peds” night out of the event.

Invite your office staff to participate. Solicit information from your billing contractor (if you don’t bill in-house) to help you understand what’s the most important information needed for successful billing of these claims.

Check us out
Enhanced assists our clients and their patients everyday by sorting out the information necessary for smooth and efficient claim resolution- for adult and pediatric scenarios alike.

How long has it been since your billing contractor provided you with insight to aid you in collecting adequate information surrounding your next pediatric run?

If the answer is either “never” or “I don’t remember when” then it’s time to check out Enhanced Management Services for help. Business Development Manager, Chuck Humphrey, is waiting to answer your questions about this and other EMS-billing-related topics. Give him a call today at (800) 369-7544 or send him a quick e-mail to chumphrey@enhancedms.com.

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