Re: Transportation Services??

[Steve Verno]

Have you looked at the HCPCS Manual?

[Pay_My_Claims]

Wow, I have had my share of ER stories, and still watch Trauma-Life in the ER. My daughter thinks I'm sick. I have been asked by my instructors about nursing...NO!! If I did I would only do ER or MICU. I hate the surgical side, and I hate OBGYN. I did think about being an EMT once just to put the defibrillator on someone!! My first day working in the ER, a young child died.

[Steve Verno]

We would have a frequent flier come to the ER. She had COPD.  While in the ER she would get a nice lunch. On the way home she would ask the ambulance staff to stop at the local convenient store to pick up some food for her home. They would do it and even go into the store to get what she needed.  Medicare would sometimes pay her claim.  She said she would never pay the bill, even when she had her deductible and coinsurance to pay.  She was 90 and didnt give a darn about her credit report.  To be honest, she was a very nice lady. No one would mess with her because she had orthopedic brass knuckles.  Her COPD was exacerbated by her heavy smoking.  When she ran low on food or was hungry, she would sit on her porch with her nasal canula and her O2 tank next to her, light up a cigarette and call the ambulance.  When they arrived, there she was in he housecoat ready to be picked up.  I met her one time. Sh was someone you would never forget.  Her fingertips were brown from all the nicotine.  As I was getting her ready for pick up, she would ask me in her deep gravley voice, "Honey, could you take me outside so I can have a cigarette."  She tried to get on the sue the cigarette company bandwagon and lost.  I dont remember when it happened, she passed away. I guess COPD finally won.  The ER wasnt the same anymore. 

[Pay_My_Claims]

Steve I have seen so many of those cases where the EMS had to do non-emergent transport and yes, "self pay". Even the visit to the ER-non emergent. (intoxication) A full moon is DEADLY on the ER. It never fails!!

[Steve Verno]

You can bill anything you wish that is documented.  The problem you face is payment for what you billed. 

Billing does not guarantee payment. 

BLS is basic life support.  Non-emergency is just that, Not an emergency.  Most insurance companies do not pay for non-emergent tansportation. 

Example:  Mrs. Jones (70) is in a nursing home. Has chest pain  transported by ambulance to the emergency room.  She is stable, has eaten a better meal than at the nursing home and is being released.  The ER calls the ambulance company to take her back to the nursing home.  The emergency no longer exists.  The transportation is non emergent with basic life support provided only.  Her insurane will pay for the trip to the emergency room and not back to the nursing home UNLESS the ambulance company obtains a Certificate of Medical Necessity (CMN) (For Medicare only).  Obtaining the CMN is a Federal law requiement.  My suggestion search the internet and read up on it. 

I would get demands for CMNs from local ambulance companies.  I would deny them because the request came in 6 months after the transportation date.  The ambulance company would have the relative (daughter) call me because now they are being billed for a denied claim.  I would inform the relative that this is not my problem, She needed to get onto the ambulance companies derrier. 
I documented that this particular ambulance company staff was more interested in getting a date with the ER nurse as i was there at one of my emergency rooms when they picked up a patient.  The doctor wasnt busy and could have signed a CMN.  This went to the State Dept of Health, CMS and DHHS. From then on, they did the paperwork before leaving the ER.  I always made sure I had all my paperwork before transporting my patients. 

If you now have an ambulance company for a client I would suggest reading the various carrier policies such as Medicare's and individual insurance companies.  You also need to be familiar with the HCPCS modifiers. 

Steve Verno, NREMT-P, MASSEMT-P (Retired)