Friday, May 2, 2014

Non-Emergency Transports- Two Questions to ALWAYS Ask

Big Brother’s Watching!
Never before has the ambulance industry been so much under the microscope when it comes to billing and receiving payment for ambulance transports- especially non-emergency transports.

Federal Government, State Governments, you name it. “Big Brother” is watching what we do.

The focus has increased dramatically over the past several years, mostly due to study after study demonstrating payments that were made to the tune of billions of dollars when most likely payments should not have been made for the services rendered at all.

Today, we’re going to focus our discussion on two questions you can ask to help you decide if your patient is medically necessary and if the non-emergency ambulance transport you are about to schedule for the patient is reasonable.
Does the patient medically require transport by ambulance?
 DON'T FORGET TO ASK! 
Ask this question and then follow with a companion question.

Is transportation by any other means contraindicated for this patient?

Your answer should be a solid YES to both if your intent is to bill Medicare for the trip. But, how do you arrive at the answer?

Read the instructions!

You’ll find the guidelines published in the Medicare Benefit Policy Manual in Chapter 10, Section 20. To be defined as medically necessary for transport the patient…
  • Was transported in an emergency situation (accident, injury or acute illness)
  • Needed to be restrained to prevent injury to himself/herself or others
  • Was unconscious or in shock
  • Required oxygen or other emergency treatment during transport to the nearest appropriate facility
  • Exhibits signs and symptoms of acute respiratory distress or cardiac distress such as shortness of breath or chest pain
  • Exhibits signs and symptoms that indicate the possibility of an acute stroke
  • Had to remain immobile because of a fracture that had not been set or the possibility of a fracture
  • Was experiencing severe hemorrhage
  • Could be moved only by stretcher
  • Was bed-confined before and after the ambulance trip

To be considered medically necessary for ambulance transport, the patient’s medical condition must be such that it rules out transportation by any other means and the patient’s condition must require both the ambulance transportation itself and the level of service provided.
Is transport by ambulance for this scenario appropriate in the first place? 
Here’s where things get a bit tricky.

In short, answering this question boils down to determining if the patient really needs to be moved by an ambulance in the first place.

The discussion begs examples and the best ones we can come up with involve transports for residents of skilled nursing facilities (SNF’s).

In all non-emergency transports there should be a review of why the patient has to move and where the patient has to move to. So for a SNF resident, if your ambulance service is requested to provide transport for a patient from the SNF to a second location for a procedure and the intention is to bill Medicare for payment of the trip, the procedure or service required by the patient has to be of such nature that the SNF can’t reasonably be expected to provide the service right there at the facility.

We can think of many such procedures or services, such as but not limited to scans, invasive surgical procedures requiring anesthesia, radiation treatments…just to name a few.

But we can also think of services the patient may need but can be accomplished without moving the patient to another location by ambulance. These services, for example, can be but not limited to, simple wound dressing changes, examinations, blood draws, foley catheter insertions and re-insertions…those kinds of simple needs where the “skilled” part of the SNF should be expected to provide the service without having to move the patient to another location.

Also, we suggest that you vet out the destination as part of your checklist for determining if the trip is reasonable or not. Remember, transports to physicians’ offices are not covered by Medicare and there are other guidelines that Medicare (CMS) spells out with regards to origins and destinations or where a patient can or cannot be transported to or from to justify Medicare payment.

Need help?
Now that you know what questions to ask, you may still be a bit fuzzy on how to apply our discussion to your ambulance company’s own unique scenarios.

That’s where Enhanced comes in. Current clients can contact your Client Services representative for help in answering the key questions regarding your transport scenario.

But what if you’re not an Enhanced client and your billing office can’t help? Well, it’s time to find a billing solution that can assist you.

Call us today at Enhanced. We’ll help you sort it all out.

By e-mail, you can reach Chuck Humphrey at chumphrey@enhancedms.com. Or, you can call him toll-free at (800) 369-7544, Extension 108.
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