Friday, October 30, 2015

“Trick or Treat” – Documenting Child EMS Scenarios

Little Ghouls and Goblins…
Tomorrow is the day the little ghouls and goblins make their rounds to collect more sugar than any parent should ever allow their children to have.

It’s almost Halloween! So, what better time than to offer some suggestions regarding documenting EMS treatment and transport of child emergencies?

“Trick or Treat” – Documenting Child EMS Scenarios

Demographics
Let’s begin with a discussion of identifying our young patients.

For billing and legality reasons, not only must we correctly identify who our patient is, by name, but we must also identify who the patient’s parent or guardian is as well. Your billing office cannot send a bill to a minor. If your patient is younger than eighteen years old, it is extremely important that you collect information about the patient’s parent or guardian before you submit the demographics as part of your patient care report.

You will be gathering the actual patient’s name and address, along with other pertinent information such as the patient’s date of birth, Social Security number, insurance coverage information and a telephone at a bare minimum. But, also you need to gather the same information from the parent or guardian.

Remember, it’s important when gathering insurance information that you gather information for the responsible person that will be the guarantor for the child. It will do your billing office no good to collect mom’s insurance information if the child is covered under the father’s policy. The same when obtaining an authorization signature, it would be preferable to keep things consistent by asking the responsible party to sign on behalf of the patient.

Again, the patient is a minor so he/she cannot sign the patient signature form unless for some reason the patient is an emancipated teenager. Emancipation is a discussion all its own and we suggest that you research your State’s individual statutes regarding what constitutes an emancipated young person.

Documenting Consent
Of course we all know that treating and transporting minors brings with it a host of challenges that are unique to these scenarios. We suggest that you really focus on your documentation with laser precision.

First off, we can think of consent issues that should be documented. We strongly suggest that you expressly document whether or not a responsible party was present and gave consent to treat and transport or if you worked with implied consent because a responsible adult was unable to be consulted and the injury or illness dictated immediate intervention. Even if your consent was secured by talking to a parent or guardian by telephone, be sure to document it. Or you may have a situation where a coach, teacher or even a babysitter…someone who has been given the responsibility of overseeing your juvenile patient at the time of the incident may be your go-to person for securing the permission to treat and transport your little patient.

And where implied consent is concerned, you must be sure to adequately document the medical necessity of the incident and especially if the situation is of a severe nature so there is never any doubt that you acted in the best interest of the patient in lieu of being able to secure direct consent to treat and transport. Naturally this will trickle down to the billing office as the responsible party you obtain consent from will most likely also be the guarantor that ultimately is responsible for seeing that your EMS agency is reimbursed for the costs of the run.

Medical Necessity
Just because our patient is young, doesn’t mean that we don’t have to document medical necessity for our young friend.

It is important to completely document your scenario. Be it illness or injury, you must fully document the nature of the incident with the thought remaining in the back of your mind that you are explaining why this incident contraindicated transport by any other means other than an ambulance.

You have the same burden of proof in substantiating medical necessity and the reasonableness of the trip that you have for an adult situation. Only the scope and type of incident change, not the basic rules to justify payment.

Two patients?
One of the scenarios we have seen become confusing to the billing office is when there are two patients, child and parent.

You may have a labor and delivery scenario, for example. What if mom delivers baby in the ambulance while on the way to the hospital?

This means you must complete two separate Patient Care Reports for billing purposes- one for mommy and one for baby. Also, make sure that you inform your billing office of this scenario as the resulting payment will be divided by most insurance payers to take into account that there were two patients in one ambulance.

Or you may have an accident situation such as a motor vehicle accident where parent/guardian and child are transported together when both were injured in the mishap. Again, it is important that two individual PCR’s be completed and be sure to inform your billing office that you transported two patients in the same ambulance.

Get Ready!
Be ready for this weekend! Little guys and girls will be out and about in your coverage area. We hope you won’t have to use any of the suggestions in this blog and your Halloween night will be incident free. But…if something does happen…you’re now prepared to nail your documentation.

The Ambulance Billing Services blog is provided as a service by Enhanced Management Services, Inc a full-service third-party EMS billing contractor serving clients across the United States. We welcome your comments. To learn more about Enhanced or to contact us about the services we provide, please visit our website at www.enhancedms.com and click on the “Get Started” button on any of the web pages.

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