Ambulance Transportation A Partnership

Transcription

1 Ambulance Transportation A Partnership

2 DUH and JAS Duke University it Hospital uses Johnston Ambulance Service for a variety of patient transports.

3 Wheelchair Van Services

4 Basic Life Support Service (BLS) Emergency Non-emergency

5 Advanced Life Support (ALS) ALS I Emergency ALS Non-Emergency

6 Medicare Covered Destination Ambulance service is covered to or from a Hospital to or from a Skilled Nursing Facility (SNF) to or from a Renal Dialysis Facility

7 Medicare never covers ambulance transportation to and from a residence to a physician s office regardless of the patient s condition Medicaid does cover ambulance transportation t ti to and from a physician s office as long as the medical necessity criteria is met

8 Medical Necessity Medical necessity is established when the patient s condition is such that the use of any other method of transportation would be contraindicated. In other words, no other type of transportation t ti could have been used without endangering the patient s health.

9 If the patient could have been transported safely by any other means, e.g., by wheelchair van, car, taxi, etc., then medical necessity does not exist. It does not make a difference whether the other type of transportation is actually available in the locality at the time of service.

10 What Does This Mean? Tell us why transportation by car, wheelchair van, or any means other than ambulance could endanger the patient s health, safety, or well being Remember, if a patient is put in a wheelchair van and when the wheelchair van turns a corner the patient (because of his or her condition) may fall out of the wheelchair and be injured, that mode of transportation is contraindicated.

11 Things to Evaluate When Determining i Medical Necessity Patient s level of consciousness Patient mobility Patient ability to sit-up Patient ability to assist in transfer from bed to stretcher Patient mental status Other factors that could effect the ability to be transported safely by any means other than ambulance

12 Nearest Appropriate Facility Medicare generally covers ambulance transportation only to the nearest appropriate facility. An appropriate facility is defined as an institution that is generally equipped to provide the needed d hospital or skilled nursing care for the patient s injury or illness.

13 When a patient is transported beyond the nearest facility, Medicare will make partial payment from the point of pick-up to the nearest appropriate facility or from the nearest appropriate facility to the residence.

14 In other words, if you are taking the patient to or from a more distant institution, Medicare will pay the base rate and a portion of the mileage equal to the distance to or from the nearest appropriate facility. However, if two or more facilities that meet the destination requirements can treat the patient appropriately and the locality of each encompasses the origin of the ambulance transportation, Medicare will cover the full mileage to either facility.

15 Physician Certification Statement It s the law July 8, 1999 HCFA issued a Program Memorandum requiring a signed Physician Certification Statement (PCS) for non-emergency transports.

16 PCS: The Form No particular format required: May be a hand written statement Suppliers and physicians may develop their own certification form Ambulance staff can not complete the PCS forms

17 PCS: The Form Documentation must describe the physical or mental diagnosis why the patient could not be transported by any other means Equally important, is having a legible signature to include the credentials of the signer

18 Repetitive Transports Before furnishing the service to the beneficiary, we must obtain a written order from the beneficiary's attending physician certifying that the medical necessity requirements are met

19 What Is Repetitive? A repetitive ambulance service is defined as medically necessary ambulance transportation t ti that t is furnished three or more times during a 10-day period or at least once per week for at least three weeks Dialysis Respiratory therapy Radiation therapy Wound Therapy

20 Non-Repetitive PCS Forms Must obtain a written order from the beneficiary s attending physician, at the time of transport, or within 48 hours after the transport, certifying that the medical necessity requirements are met

21 If unable to obtain a signed PCS from the attending physician, it must obtain from: Physician Assistant (PA) Nurse Practitioner Clinical Nurse Specialist Registered nurse or Discharge Planner Signer must have personal knowledge of the beneficiary s condition at the time the ambulance transport is ordered or the service is furnished Si t b l d b th Signer must be employed by the beneficiary s attending physician or by the hospital or facility from which the beneficiary is transport

22 21 Day Rule If unable to obtain the required certification within 21 days following the date of the service, the ambulance supplier must document attempts to obtain the requested certification and may then submit the claim Acceptable documentation: Signed return receipt from the U.S. Postal Service or other similar service that evidences that the ambulance supplier attempted to obtain the required signature from the beneficiary s attending physician or other individual who is permitted to sign

23 Documentation In all cases, appropriate documentation must be kept on file and presented to carrier upon request It is important to note that neither the presence nor absence of the signed physician certification statement necessarily yp proves (or disproves) whether the transport was medically necessary

24 Process for Setting Up Ambulance Transport Complete the Ambulance Transport form and fax it to Duke LifeFlight Communications at In Canopy, complete the Assessment tool entitled Ambulance Transport In Canopy resources, complete the resource entry to show the arrangement of the ambulance. Communicate to the patient, family, healthcare team of when the ambulance is expected to arrive. Document these conversations in the progress note in Canopy.