Wednesday, November 27, 2013

Family, Friends and Responsible Persons

That time of year…
Thanksgiving, Hanukkah, Christmas, New Years is a time to get together with family and friends. In the spirit of the season, we’ll take a few lines to discuss the importance of gathering relationship and guarantor information as part of the documentation you prepare following your EMS incident.

The Old and the Young
We often field questions from our clients and their staff members about the importance of identifying the responsible party for payment of the ambulance claims that produce reimbursement to your EMS organization.

One of the best rules of thumb is to remember that more times than not, older persons and younger persons (infant to 17 years old) will have someone who takes care of their healthcare affairs.

Right off the bat you, as a field provider and eventual documenter, must remember to help your billing office by collecting—at the very least—the name and hopefully an address and/or phone number of the person who will ultimately assist you with the billing process.

These people are often called guarantors or in some cases they are guardians. They include parents, next-of-kin such as a spouse or adult child, siblings, close friends, third-party agents such as a patient advocate or a court-appointed guardian, or even an employee or volunteer of an advocacy agency to who care has been assigned for those persons who cannot adequately or legally make their own decisions.

Obtaining Signatures
Once you have identified who the responsible person is that will act on behalf of the patient, your next step toward closing the documentation loop will be obtaining an authorization signature from that person.

Because of the legal nature of their relationship to your patient, these people should be able to sign and by doing so bind him or herself to take responsibility for payment for the ambulance transport you just completed.

The signature form you use should spell out the relationship to the patient and why the patient could not sign for himself/herself. In most cases, but not all, the person signing the authorization forms we all carry in our ambulances enable you, as a representative of your EMS organization, to procure a “promise” form the person signing that he/she will take responsibility for the ultimate payment of the resulting claim.

This includes whether or not the resulting ambulance bill is paid by insurance or paid from personal funds. The person signing, in essence, takes ownership of the payment scenario for this particular patient and understands a bill for the service will arrive in the patient’s name soon after the incident.

Of course, we highly recommend when anyone but the patient signs off on the run that you collect that person’s printed name in proximity to their signature (especially if the signature looks more like a 3-year-old’s art project than a legible, legitimate signature.) Also be sure to know where you can contact them with questions pertaining to the billing of the run.

Other signature sensitive parts of the billing scenario are any “waivers” obtained from the patient or the responsible party acting on behalf of the patient. Be extra careful when obtaining signatures on these documents that you are certain, without a doubt, that the person signing the waiver form fully understands that he/she will be held responsible for making sure that the resulting claim is paid one way or the other.

Identifying the Correct Responsible Person
It is important that you clearly identify the responsible person that will act on behalf of the patient and why the patient cannot make his/her own decisions. In some cases it would be best to document the nature of the incident and the relationship, especially as permissions are given (or not given) for treatment and transport of the patient.

For non-emergency transport scenarios, we advocate that it’s best for the call-taker or dispatcher to be certain by whom and by what means the bill will be paid.

Put together a call-intake form that is by every single phone in your station or is at the side of every single call-taker or dispatcher.

If a waiver form or Medicare Advance Beneficiary Notice (ABN) must be presented within the scenario, be sure to properly identify the person who is authorized to sign on behalf of the patient in such a scenario and it would be best to have that form completely filled out (as permitted with the exception of the signature of course) and ready for the crews to pick-up prior to leaving the station on the run.

Once in the patient’s family/guardian’s presence, the form can then be given to the responsible party for review and signing.

We suggest that you consider documenting in your Patient Care Report, especially in waiver situations, regarding the presentation of the form…

“Patient is an 81-year-old male with severe dementia. Patient’s power of attorney (his sister) was on the scene. An Advance Beneficiary Notice was presented to the POA. The POA read the entire ABN, verbalized to this crew that she understood that the patient and by extension she may be responsible for payment for this ambulance transport, acknowledged the potential cost of the trip and signed the ABN, electing to authorize the transport despite the uncertainty of payment. A copy of the ABN was given to the POA prior to the beginning of the transport.

Enjoy your holiday season. Use this time of year, filled with family and friends, to help remember some of the suggestions we have outlined today as pertaining to the involvement of responsible persons in the care.

Responsible persons are important people for you, as a representative of your EMS organization; to identify, interact with and sometimes even procure permissions from on behalf of your patient.

Your billing office will so appreciate that you have gained understanding of this issue and are applying what you have learned to allow accurate claim processing following the ambulance run.

Contact Us…
Enhanced clients who have questions regarding this topic can contact either Pam or Heidi in Client Services.

Is your organization not yet receiving this kind of instruction? Sounds like it’s time to contact our Business Development Manager Chuck Humphrey to find out how you can receive billing-related education like this and much more. Enhanced does more than just “send bills.” Business Development Manager Chuck Humphrey can tell you how your EMS organization can benefit from becoming an Enhanced client. Call him today at (800) 369-7544, Extension 108 or by e-mail to
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