When Other Healthcare Disciplines Don’t Know Ambulance
“I worked in healthcare.”
One recent caller to our billing office started a conversation in this way when he called to question his ambulance bill.
The patient called because he had received notice that we had billed Medicare on behalf of one of our EMS agency clients. The gentleman was a retired from a non-EMS healthcare discipline and he was “ticked off” to say the least for what he perceived to be billing at an incorrect level of service.
This scenario comes up from time-to-time.
Persons involved in healthcare, outside of the ambulance industry, often don’t understand the unique rules that drive billing for EMS. So, they naturally attempt to apply other non-ambulance billing guidelines to their set of circumstances.
ALS Level Dispatch
This particular scenario was one of an ALS dispatch with ALS assessment, but no ALS interventions provided.
The person suffered a potentially life-threatening traumatic injury.
The patient’s family activated the EMS system reporting the emergency and relayed the patient has a history of a past injury that may have been aggravated by the current trauma and was experiencing difficulty breathing. The 9-1-1 call-taker appropriately prioritized the call following the established dispatch protocol in place and advised for dispatch at the highest priority for an ALS emergency response due to the reported extenuating circumstances.
Not what it appeared to be…
The EMS crew who responded immediately following the dispatch arrived at the scene and a paramedic immediately assessed the patient.
Fortunately for the patient, the scenario turned out to not be as serious as feared by the patient’s family when they dialed 9-1-1.
While the patient did injure himself, the injury was not life-threatening and his existing; past-injury was not exacerbated. The difficulty breathing turned out to be simply that the patient had the wind knocked out of him…scary yes, life-threatening, no.
The resulting patient care report for this incident appropriately documented that the 9-1-1 dispatch priority was an ALS-level dispatch of the highest priority for this particular geographic area.
The paramedic on the call documented that he performed an ALS assessment, recorded all pertinent findings and adequately explained why no ALS-level interventions were deemed necessary in this scenario. The patient was subsequently transported by the EMS agency to the hospital for treatment.
The Bill
When the patient received the notification that our office was billing Medicare for his treatment and transport at the ALS level, it sparked him to call to ask questions.
In his mind, billing for an ALS level of care when no ALS interventions were initiated constituted an improper billing practice. The patient deduced that our office in conjunction with our EMS agency client was billing for a higher level than the incident called for.
The patient was basing his complaint on what he thought he knew about correct billing practices drawn from his knowledge of billing in the context of his former employment outside the ambulance industry.
Correctly Billed
By now, I’m sure you’ve figured out that there was no wrongdoing either by our office or by the ambulance company we represent.
Medicare guidelines as outlined in Chapter 10 of the CMS Medicare Benefit Policy Manual clearly allows for the claim to be billed based on the level of dispatch and the fact that an assessment was performed by an ALS-level provider even though ALS interventions were not warranted for this scenario.
The ambulance crew responded with an appropriate ALS crew including an EMT and a paramedic. The paramedic assessed the patient and determined that there were no ALS interventions necessary and the patient was packaged and transported to the closest appropriate hospital emergency department for further evaluation for the injury sustained in the incident.
The Keys…
We end this discussion by pointing out two key documentation elements that allowed our office to properly bill this scenario to Medicare as an ALS 1 Emergency.
- The level and priority of dispatch were recorded in the PCR. In this case not only was the level of dispatch priority recorded by the crew but a copy of the 9-1-1 center’s CAD notes were scanned and attached within the EPCR program as proof. The call-taker’s notes clearly explained why an ALS-level dispatch was initiated.
- An ALS assessment was appropriately documented. The paramedic detailed his assessment and objective findings using clear clinical documentation to support his decision to not initiate ALS interventions but to transport the patient for future care sans those interventions.
For a more detailed look at billing for ALS Assessments with no ALS interventions, feel free to visit the blog post from February 21, 2014 entitled “Billing for ALS Assessments”.
