Inter-Facility Transfers
This week’s blog will focus on inter-facility transports.
For the most part we’ll discuss hospital-to-hospital
transfers where the patient has been treated at one hospital but must move to a
different hospital in most cases for care that is not provided at the facility
where they currently are located.
Community Hospitals
We find, as we read our client’s Patient Care Reports (PCRs)
that these EMS scenarios many times originate at a community hospital- a local
facility equipped to handle emergencies and provide basic care many times to
the point of even stabilizing a patient experiencing a medical emergency, but
not equipped to further care for the patient’s specific needs.
While in every way the facility is defined as a hospital, complete with
inpatient beds, but focused on providing basic care minus specialties or
critical care capabilities.
Once the patient is stabilized or possibly the patient’s
overall status worsens and becomes more critical, it’s at this point that the
patient’s condition warrants the transfer of the patient using an ambulance
with equipment and personnel who can provide trained monitoring to safely
transport the patient to a second facility better equipped to properly provide
the specialized care needed.
Closest Appropriate Facility
Just two weeks ago we used this space to dig into the
concept of the “appropriate” facility as defined in the Medicare Benefit Policy
Manual. Revisit the blog in the archives to refresh your memory regarding this discussion.
However, allow us to remind you that for Medicare, Medicaid
and most insurance payers to reimburse the EMS agency for these transports
there must be documentation in the PCR describing the transport noting the
patient’s condition clearly warranted the need for a higher level of care.
Be Specific!
The PCR must be specific.
The documentation in the PCR must clearly and precisely
indicate what service is not available at the first or sending facility that is
available at the second or receiving facility. It’s quite simple, but cannot be
vague.
Consider these examples…
The right way
– Patient presented suffering a STEMI. Cardiac
catheterization is not available at Hospital A requiring this patient to be
transported by ambulance to Hospital B where cardiac catheterization is
available
The wrong way
– Dispatched to Hospital A for an
inter-facility transport. Patient suffered a heart attack and required
transport by ambulance for higher level of care.
Comments - The first example was precise and left
no doubt as to the reason for the transport. The second example is vague and
did not adequately describe why the patient must leave a fully accredited
hospital to be transported to another hospital. If the documentation in the
second example was all that the PCR contained, your billing office should be
raising many red flags and asking you for clarification before creating the
claim and billing the payer for reimbursement.
Here’s another comparison…
The right way
– Patient presented in the emergency department
at Hospital X having suffered a left-sided pelvic fracture following a fall at
home. Patient was treated to control the pain. Hospital X has no orthopedic
surgeon on staff requiring transport to Hospital Y for treatment, evaluation
and possible surgery by an orthopedic surgeon.
The wrong way
– Patient presented in the emergency
department at Hopsital X with a pelvic fracture following a fall at home. Patient
was treated to control the pain. Patient loaded in ambulance and transport to
Hospital Y for treatment of the fracture.
Comments - Again,
note the contrast in the two examples. The first example is specific regarding
the injury, what care was provided at the first hospital and what care cannot
be provided and is available at the second hospital. The second example leaves
the open question as to why the first hospital was unable to properly care for
and stabilize the fracture. The second example leaves doubt in the mind of the
reader of the PCR as to the need for the ambulance service.
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
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