Signatures, or the lack thereof

[JakeEMTP]

In other words, you don't run IFTs.

Umm. no. 8)

However, our call volume from nursing homes has increased since the Medical Director refuses to allow BLS transfer services to transport anything to the ED anymore.

[JakeEMTP]

See, that's strange to me. All I had to do with patients who couldn't sign was mark a box and sign a declaration and fill in a reason for why the patient couldn't sign. It's not signing for them, it was simply stating that the patient couldn't sign.

Yeah, it kinda blows. Not everything we do here makes perfect sense, This is but one of them. I can't remember the exact wording of the document, but it is just stating the patient is unable to sign and that as their EMS provider ( ie Guardian ) I am signing for them.

[JPINFV]

However, our call volume from nursing homes has increased since the Medical Director refuses to allow BLS transfer services to transport anything to the ED anymore.

Brilliant

[JakeEMTP]

I love those guys!

[Richard B the EMT]

Call report has a couple of check-boxes.

1) Patient or responsible party signature,

2) Patient or responsible party unable to sign (Document why)

3) Patient or responsible party Refused to sign

2 boxes to sign in, one the patient or responsible party, the other for the ambulance crew if box 2 or 3 checked.

[Doczilla]

"Patient Unable to Sign" is no longer acceptable.

I'm not sure if this has been covered here recently (a search was not helpful), but the law has recently changed regarding obtaining signatures. If the EMS "Assignment of Billing" (consent to bill insurance, frequently on the EMS run report itself) isn't signed by the patient or a proper representative, Medicare will not pay for the transport. If the patient is unable to sign, you must document why. This applies particularly to emergency runs.

http://www.pwwemslaw.com/content.aspx?id=321

Signature requirements for filing Medicare claims in instances where the beneficiary is unable to sign will change significantly as of January 1, 2008. Under the provisions of a Final Rule published by the Centers for Medicare and Medicaid Services (CMS) in the November 27, 2007 Federal Register, in those instances where a beneficiary is physically or mentally unable to sign an Assignment of Benefits (AOB) form, ambulance suppliers will be required either to obtain the signature of an acceptable surrogate, or, with respect to emergency ambulance services, meet stringent new documentation requirements before submitting the claim to Medicare. These rules will substantially affect 911 emergency ambulance providers in particular. These new requirements include three types of documentation:

(A) A signed, contemporaneous statement from an employee of the ambulance service, present during the transport, documenting that the patient was physically or mentally incapable of signing and that no other authorized signers were available or willing to sign; AND

( Documentation with the date and time the patient was transported, and the name and location of the receiving facility; AND

© Either of the following:

(1) A signed, contemporaneous statement from a representative of the receiving facility, which documents the name of the patient and the date and time the patient was received by that facility; OR

(2) A "secondary form of verification," obtained at a later date, but prior to submitting the claim to Medicare, which may include:

(i) A hospital representative signature on the ambulance trip report;

(ii) The hospital registration/admissions sheet;

(iii) The patient medical record; or

(iv) "Other internal hospital records."

These rules became effective on January 1, 2008.

The Final Rule makes it clear that this alternative applies only to emergency ambulance services; in other words, CMS is implying that ambulance services can no longer rely on the "patient unable to sign" rule for non-emeregncy claims; a signature of the beneficiary or some authorized signer must be obtained prior to submitting the claim to Medicare for non-emergency ambulance claims.

In short, this new Final Rule is going to substantially change the way ambulance services do business, and it will significantly increase the need for complete and thorough documentation - including signatures - at the time ambulance services are rendered. If no signature is obtained at the time of service, ambulance services should expect their claim filing and cash flow to be significantly delayed.

If you wanna get paid, lifesaver, you gotta get it signed.

'zilla

[JPINFV]

Since I'm not currently in the field, would C be covered by a signature of the person who care is being transfered to or a face sheet? A can be covered with a good run sheet design (deceleration on the back) and B should be covered in the run sheet, period (well, depends on what they mean by "location").

Edit:

Looking at a link from Doczilla's website here: http://www.pwwemslaw.com/CMS/uploads/File/...-%20V%201.4.pdf

I really fail to see what the hee haw is. Generally registration is 'johnny on the spot' when bringing a patient to the ER anyways, so you should be able to get a rather quick face sheet from the facility. Similarly, a signed PCR counts also. So, if people are getting their PCRs signed by the staff, then it should take 30 seconds to fill out an extra form and bingo, complied with the new rule.

[AnthonyM83]

We have a triple check...We get 1) Patient Signature 2) Nurse Signature 3) Medical Record # / Facesheet

If we fail on one, we still have two others.

[Doczilla]

Since I'm not currently in the field, would C be covered by a signature of the person who care is being transfered to or a face sheet?.

Yes.

I really fail to see what the hee haw is. Generally registration is 'johnny on the spot' when bringing a patient to the ER anyways, so you should be able to get a rather quick face sheet from the facility. Similarly, a signed PCR counts also. So, if people are getting their PCRs signed by the staff, then it should take 30 seconds to fill out an extra form and bingo, complied with the new rule.

I agree. It's a simple thing to do, but plenty of folks don't do it.

'zilla

[AnthonyM83]

Oh, except we don't sign our the new ePCR's (they're not actually electronic, just have a lot of boxes for easy scan and keeping track of them later electronically in billing and compiling data, etc)...so not sure how we're getting around that...but I know we've been getting about 20% of a compliance rate with getting insurance to pay.