Ask Your Billing Questions Here!

[BillingSpecialist]

I've been getting patient signatures left and right like a good doobie.

Good! I'm sure the billing people appreciate it VERY much

 

[rails]

Wonderful thread.

Does information on how a patient got to the stretcher make an impact on billing, and/or does information on how the patient got transferred to the hospital bed make an impact?

In other words, is it helpful when I include statements such as "Transferred patient to EMS stretcher from nursing home bed via draw-sheet method", or "Transferred patient to ER bed from EMS stretcher via draw-sheet method"? Or is it a waste of narrative?

 

[BillingSpecialist]

Thank You!!

Yes that information is VERY helpful. It's more documentation to prove the patient had to go by stretcher. The more documentation you put on the run to support the patient's means of transport needed to be by ambulance the BETTER!!

Of course it has it downsides too though, for example when you have a patient that walked to the cot But if it happened that way you must put it too. It may not be payable by the insurance companies, but it can still be billed, it will just be patient responsibility.

 

[rails]

Awesome. Thank you!

Two more questions:

1. How do the primary and secondary impressions impact billing?

2. With regard to Medicaid and Medicare, do # of drugs administered impact billing? I thought I heard that 3 drugs placed it in a higher payment tier than 2 drugs, etc.

 

[Jim37F]

What about 911 calls where the patient doesn't really have a medical complaint? We legally cannot refuse ambulance transport for 911 calls, yet if there was no real medical need for an ambulance, how do those get billed?

 

[Kevinf]

Wonderful thread.

Does information on how a patient got to the stretcher make an impact on billing, and/or does information on how the patient got transferred to the hospital bed make an impact?

In other words, is it helpful when I include statements such as "Transferred patient to EMS stretcher from nursing home bed via draw-sheet method", or "Transferred patient to ER bed from EMS stretcher via draw-sheet method"? Or is it a waste of narrative?

If you are charting that, you probably should chart WHY they needed to be draw-sheet transferred or otherwise. Was it because it was easier or quicker for you or because the patient was completely incapable of other methods of transfer? Just like you would chart that you placed an IV, but was it due to clinical necessity or because you get a talking to if you don't do it for every transport?

 

[rails]

If you are charting that, you probably should chart WHY they needed to be draw-sheet transferred or otherwise. Was it because it was easier or quicker for you or because the patient was completely incapable of other methods of transfer? Just like you would chart that you placed an IV, but was it due to clinical necessity or because you get a talking to if you don't do it for every transport?

Oh, for sure. I typically add a statement in there about why the patients needs ambulance transport, as well.

I was just curious about the pt transfer statements specifically, because I've worked with others who never write in their narrative. A couple of others told me they didn't think the statements made any impact on billing whatsoever. I figured I'd ask a billing expert, to throw the answer into the equation of weighing out whether to keep doing those statements or not.

 

[BillingSpecialist]

Awesome. Thank you!

Two more questions:

1. How do the primary and secondary impressions impact billing?

2. With regard to Medicaid and Medicare, do # of drugs administered impact billing? I thought I heard that 3 drugs placed it in a higher payment tier than 2 drugs, etc.

Primary impression should be what you're dispatched for correct? And then secondary impression should be what you observe once you arrive to the patient correct? That being said, yes they are very important. A call can be billed by the way a call is dispatched For example you get a call and are dispatched for a patient with chest pain, medic is on this call, making it an ALS call, then you arrive on scene to find patient actually only has pain in their big toe....which definitely doesn't call for a medic. But medic would still assess the patient and then deem the call a BLS call. Because the call was dispatched ALS & the medic did their assessment, this call could still be billed as an ALS trip. But of course all the details must be documented!

Yes, the number of drugs that are used will allow the billing company to bill it differently, at a higher rate. There is another way to also bill at the higher rate. This would be billed as an advanced life support, level 2 (ALS2). An ALS2 is billed when one of these two things apply (1) at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding Saline) or (2) one of the ALS2 procedures: 1-Manual defibrillation/cardioversion 2-Endotracheal intubation 3-Central venous line 4-Cardiac pacing 5-Chest decompression 6-Surgical airway or 7-Intraosseous line are performed on the patient.

 

[BillingSpecialist]

If you are charting that, you probably should chart WHY they needed to be draw-sheet transferred or otherwise. Was it because it was easier or quicker for you or because the patient was completely incapable of other methods of transfer? Just like you would chart that you placed an IV, but was it due to clinical necessity or because you get a talking to if you don't do it for every transport?

Absolutely! The "Why" is very important. If the "why" isn't there, you'd probably end up seeing a QA flag asking that question. From the billing side, there's no diagnosis code for a transfer via draw sheet method. So it would need to be specified as to why patient needed that draw sheet lift, and that reason or reasons would be coded by the billing staff.

 

[BillingSpecialist]

What about 911 calls where the patient doesn't really have a medical complaint? We legally cannot refuse ambulance transport for 911 calls, yet if there was no real medical need for an ambulance, how do those get billed?

Right, you can't refuse to take them. You have to document those clearly, and they may not be billable to the insurance companies like that, but they are definitely billable to the patient.

 

[Jim37F]

You can bill ALS rates simply based on what dispatch says? Here in my county, every call gets a Paramedic unit assigned. County Fire sends a Paramedic squad and us on the BLS ambulance....some of the FDs only have dual medic ambulances that transport all calls regardless if it's toe pain or chest pain....does that mean everyone who calls 911 here will get an ALS bill? And what if our ePCR has no spot to put in what dispatch says the call is, we only write what's actually going on. There's a box to check if the patient was moved to the ambulance via stretcher or if they walked into it, nothing to say how they got in or out of the stretcher though, and we don't write that in the narrative either, and no one has ever said anything about that.

 

[BillingSpecialist]

You can bill ALS rates simply based on what dispatch says? Here in my county, every call gets a Paramedic unit assigned. County Fire sends a Paramedic squad and us on the BLS ambulance....some of the FDs only have dual medic ambulances that transport all calls regardless if it's toe pain or chest pain....does that mean everyone who calls 911 here will get an ALS bill? And what if our ePCR has no spot to put in what dispatch says the call is, we only write what's actually going on. There's a box to check if the patient was moved to the ambulance via stretcher or if they walked into it, nothing to say how they got in or out of the stretcher though, and we don't write that in the narrative either, and no one has ever said anything about that.

Just because a Medic is on the call, that doesn't make it an ALS call & it can't be billed as such. But if according to your protocols, if the dispatch reason falls into those ALS protocols, then yes it can be billed as an ALS. Just like the chest pain & toe pain example I gave, because the chest pain falls under the ALS protocols and was dispatched that way, it is a billable ALS call. But if the call would have been dispatched as toe pain, then that shouldn't fall into ALS protocols, and should be responded to as a BLS call. Just because the Medic is on the call, that doesn't automatically make it an ALS call.

You would have to write it in your narrative, for example this is what a narrative would look like for the chest pain/toe pain example:

Dispatched for patient experiencing CP, Medic Jones on board call. Upon arrival to pt, found pt to be having right big toe pain and no chest pain. Medic Jones assessed pt and found no need for ALS interventions and deemed transport a BLS transport. Care turned over to EMT Smith. Pt states the she stubbed her toe on the sidewalk while walking her dog. Sh stumbled to the ground and also had a scrape on her knee. Assisted pt to cot, as she was unable to place full weight on her right foot. Vitals within normal limits, pt monitored en-route to hospital with no changes in condition, care turned over to Nurse White in the ER.

How the patient got to or from the stretcher isn't something that "has" to be there, but it is always helpful. The more documentation that is on a run, the better. But it is also something that would have to be placed in your narrative. I would say it's never been mentioned or never asked to be on the run to avoid seeing things like "patient walked to cot" "patient climbed on cot" "patient walked to the ambulance."

 

[Jim37F]

Just because a Medic is on the call, that doesn't make it an ALS call & it can't be billed as such. But if according to your protocols, if the dispatch reason falls into those ALS protocols, then yes it can be billed as an ALS. Just like the chest pain & toe pain example I gave, because the chest pain falls under the ALS protocols and was dispatched that way, it is a billable ALS call. But if the call would have been dispatched as toe pain, then that shouldn't fall into ALS protocols, and should be responded to as a BLS call. Just because the Medic is on the call, that doesn't automatically make it an ALS call.

You would have to write it in your narrative, for example this is what a narrative would look like for the chest pain/toe pain example:

Dispatched for patient experiencing CP, Medic Jones on board call. Upon arrival to pt, found pt to be having right big toe pain and no chest pain. Medic Jones assessed pt and found no need for ALS interventions and deemed transport a BLS transport. Care turned over to EMT Smith. Pt states the she stubbed her toe on the sidewalk while walking her dog. Sh stumbled to the ground and also had a scrape on her knee. Assisted pt to cot, as she was unable to place full weight on her right foot. Vitals within normal limits, pt monitored en-route to hospital with no changes in condition, care turned over to Nurse White in the ER.

How the patient got to or from the stretcher isn't something that "has" to be there, but it is always helpful. The more documentation that is on a run, the better. But it is also something that would have to be placed in your narrative. I would say it's never been mentioned or never asked to be on the run to avoid seeing things like "patient walked to cot" "patient climbed on cot" "patient walked to the ambulance."

ok, a typical narrative here for this hypothetical would look something like: "(Age) y.o. M pt found sitting in chair inside residence, pt A&Ox3, GCS 4-5-6 (15), (under care of applicable FD if they were on scene first) CO pain to L big toe, secondary to accidentally kicking a nightstand while dancing with his wife. +CMS, -deformity, +swelling -other injury, Pt denies any other pain, injury, or discomfort. Pt assisted into gurney and transported POC, semi-fowlers. Pt transported C2 -PMA (Code 2, no lights or sirens, negative paramedic assist) to XYZ hospital for eval and tx. Pt required BLS monitoring enroute, -changes to Pt condition enroute."

So we wouldn't write anything about chest pain or Paramedics involved (even though they'd be there and doing the assessment until we started transporting). The FD medics would do their own run sheet in addition to ours, so does that make a difference?

 

[BillingSpecialist]

ok, a typical narrative here for this hypothetical would look something like: "(Age) y.o. M pt found sitting in chair inside residence, pt A&Ox3, GCS 4-5-6 (15), (under care of applicable FD if they were on scene first) CO pain to L big toe, secondary to accidentally kicking a nightstand while dancing with his wife. +CMS, -deformity, +swelling -other injury, Pt denies any other pain, injury, or discomfort. Pt assisted into gurney and transported POC, semi-fowlers. Pt transported C2 -PMA (Code 2, no lights or sirens, negative paramedic assist) to XYZ hospital for eval and tx. Pt required BLS monitoring enroute, -changes to Pt condition enroute."

So we wouldn't write anything about chest pain or Paramedics involved (even though they'd be there and doing the assessment until we started transporting). The FD medics would do their own run sheet in addition to ours, so does that make a difference?

Yes, that would make a difference. Does the fire department bill for anything? If they do then they'd bill for their services & your squad would bill for theirs.
Is the fire department and squad that responded from the same organization?

 

[Jim37F]

Yes, that would make a difference. Does the fire department bill for anything? If they do then they'd bill for their services & your squad would bill for theirs.
Is the fire department and squad that responded from the same organization?

We are a private company, contracted to the FD for transport since they choose not to do that themselves. County Fire does not bill. Not sure off the top of my head for the other 2 smaller departments (each a municipal city FD) we run with. In any case, any and all EMS calls with these 3 FDs will get an engine or truck company, and a rescue squad from the FD (meaning a dual FF/PM ALS unit typically in a heavy duty work truck that carries all their ALS supplies and a small selection of tools for rescues, through that's primarily the job of the engine company) and then we show up in the ambulance.

 

[rails]

BillingSpecialist, could you ever put together a general "top ten" list of why EMS run insurance claims are denied? That would be really interesting to me.

 

[BillingSpecialist]

We are a private company, contracted to the FD for transport since they choose not to do that themselves. County Fire does not bill. Not sure off the top of my head for the other 2 smaller departments (each a municipal city FD) we run with. In any case, any and all EMS calls with these 3 FDs will get an engine or truck company, and a rescue squad from the FD (meaning a dual FF/PM ALS unit typically in a heavy duty work truck that carries all their ALS supplies and a small selection of tools for rescues, through that's primarily the job of the engine company) and then we show up in the ambulance.

Since they have contracted you, then is there a fee they pay your for running calls with them? Since you guys aren't billing the ALS calls now, I'm guessing there's not a agreement set up for you to do that now. Maybe something that would be a possibility to add to the contract when it's renewal time. Like the contract giving you permission to bill as an ALS call with a cop y of the FD's report. You could bill them ALS then, but it would have to be written up and agreed on by both parties.

Municipalities work a little differently, often by rules of their own....so all of the above is just a suggestion of course. I hope this has been a helpful conversation and not a confusing one

 

[BillingSpecialist]

BillingSpecialist, could you ever put together a general "top ten" list of why EMS run insurance claims are denied? That would be really interesting to me.

Yes, I could do that, I'll work on it and post it this week

 

[Jim37F]

Since they have contracted you, then is there a fee they pay your for running calls with them? Since you guys aren't billing the ALS calls now, I'm guessing there's not a agreement set up for you to do that now. Maybe something that would be a possibility to add to the contract when it's renewal time. Like the contract giving you permission to bill as an ALS call with a cop y of the FD's report. You could bill them ALS then, but it would have to be written up and agreed on by both parties.

Municipalities work a little differently, often by rules of their own....so all of the above is just a suggestion of course. I hope this has been a helpful conversation and not a confusing one

We do the ALS transports for them also, the fire medic simply hops in the back of our ambulance with his gear and we transport ALS that way (documented as such) so I'm pretty sure we'll bill for ALS as well

 

[BillingSpecialist]

We do the ALS transports for them also, the fire medic simply hops in the back of our ambulance with his gear and we transport ALS that way (documented as such) so I'm pretty sure we'll bill for ALS as well

Yes, those would definitely be billed ALS & I'm sure you right that they're billing those as ALS calls.