Friday, February 26, 2016

Of “Ambulance Drivers” and “Emergencies”

All of the times…
Can you count all of the times that you have been labeled an “ambulance driver”?

Of “Ambulance Drivers” and “Emergencies”
Nearly half a decade removed from the dawn of modern EMS, to our neighbors that’s what we are…ambulance drivers. Regardless of all of the hours you’ve spent training to attain your certification level- EMT-B, EMT-I, EMT-P, PHRN…whatever lever you’ve attained; to most people you’re an “ambulance driver”.

All Ambulance is “Emergency”
Likewise, every single time an ambulance passes there must be an “emergency”. Yes, every single time.

Of course, we all know that the true life-threatening emergency is more the exception than the rule and a lot of what we all do is move people around. Now don’t take this the wrong way, we acknowledge that the majority of the people we move truly require our services. Sure there are those persons that summon us when they really don’t need us and that certainly causes us frustration. Plus there are those that seem to always want to “fall and can’t get up” that we have to roll out to help at 0200.

Can we classify these as emergencies? Probably not.

Emergency Defined
Remember; this is an EMS billing-centric blog. So we discuss all things billing-related using the written word.

Our training always carries a caveat to remind the reader to remove his/her operations hat and replace it with the billing hat. That may not be easy for some of you because you don’t do what we do day-in and day-out. But, we believe that the true reason this blog space is read at all is because we do differentiate the street side of our business from the office side of the business.

So while the public may think everything we do is an “emergency”, the billing definition points to something completely opposite.

An Emergency response can be a BLS or ALS 1 Level of service that has been provided in immediate response to a 9-1-1- call or the equivalent in areas that do no utilize a 9-1-1 alert system. An immediate response is defined when the ambulance takes the necessary steps to respond as quickly as possible to the call for assistance.

The ambulance incident is emergent in nature when a dispatcher initiates an emergency dispatch based on information collected from the reporting person using pre-determined accepted and standard dispatch protocol.

The Centers for Medicare and Medicaid Services uses this definition to make the point that there must be two elements to consider the incident an emergency…the standard or protocol which the incident is filtered through coupled with the immediate nature of the response.

Billing Tension
The billing office tension happens when a patient receives a bill and cannot understand why an insurance payer won’t pay because they determine the transport to not be an emergency. The billing office tension comes when the insurance payer’s customer service representatives tell a patient that the claim would have been paid had the ambulance billing office simply coded the claim as an emergency when the incident in question failed to meet the above emergency definition criteria.

Because everybody perceives that we “ambulance drivers” transport patients in an “emergency vehicle” then by extension ALL ambulance runs are emergencies. Right?

So the patient and/or the patient’s family/representative are often incensed by the fact that we would dare label an ambulance transport as a…don’t say it…
<<GASP>>
NON-EMERGENCY!!!
Because…there’s no such thing, right?

Full Circle
You’re reading this because you’re interested in EMS billing. By now you should be used to how this post ends. The full circle conclusion is…documentation.

Your documentation in the patient care report is always the key determinant in these situations. If, as an EMS provider, you fail to capture the nature of dispatch, describe the incident using clear clinical documentation to paint a picture in word describing your incident; then the tension we described above will exist.

Save your patients the stress. Save your billing office the stress. Be detailed and complete with your documentation. The rest will take care of itself!

The Ambulance Billing Services blog is brought to you as an educational tool by Enhanced Management Services, Inc.  Enhanced Management Services, Inc. is an all-EMS third-party billing contractor serving Fire/EMS agencies across the United States.  To learn more about who we are and what we do, please visit our website at www.enhancedms.com and click on the “Get Started” button on any landing page.

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