Christopher.Collins Posted December 30, 2008 Posted December 30, 2008 So I was reading through an old post about the security of our jobs and future in EMS because of the economy; http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight= I came across a post that I had replied too: I really don't think that our lovely ems system will suffer from whats going on its a thing called MEDICAL and MEDICARE Now I dont know if the poster was being sarcastic or not but I had replied: Well... sure maybe. But I see more and more people saying they dont want to go to the hospital because they cant afford it. Or drive themselves to at least avoid one bill. Hell, just yesterday I picked up an elderly man with abdominal pain. We were in the midst of a snow storm that made driving an act of insanity... and they still tried to drive themselves. Finally his wife pulled over and called 9-1-1. Bear in mind also that not everyone has insurance... and not all insurance is accepted. Dont forget to sign off on your paperwork why the patient NEEDED an ambulance. Medicare often wont pay up if your patient walked to the stretcher... but also, if you didnt document that your patient walked to the stretcher then it didnt happen, so howd they get there? ... What Im wondering... if anyone knows anything about how companies like medicare operate is how they get off defining who needs an ambulance? As we have disscussed in other threads even a simple tooth ache could be a serious emergency waiting to happen... and pretty much that untill a doctor diagnosess otherwise anything could be an emergency. Now we all know that there are abusers of the 9-1-1 system and that not every emergency is actually an emergency but regardless thats not our decision to make in the field. So who is medicare to say otherwise? Additionally, I dont know how other companies operate... but regardless of any agency Ive worked for recieving payment or not I still get paid at the end of the week. So how does no payment on medicare or patient part usually effect a company? Generally we grunts are told not to concern ourselves with billing matters, but if anyone knows Im curious. Even if the patient can afford transport... is there a difference in their payment vs. medicare? Also... at least around here, they often wont pay if your patient walked to the stretcher. In one company I have on many occasions refused to falsify how my patient got on the stretcher just so we could get paid. I write all of my PCRs like they are being reviewed in court. But seriously... should a patient not be allowed to ambulate in ANY emergency? Sure in cases of trauma and sever respritory distress or anything related I can understand the need to help them. But just because my patient can SAFLEY walk dosnt mean they are not in need of an ambulance. Again, just curious on how all this works. Maybe its not important for the grunts to know... but maybe knowledge on how our "bank" works will make things easier in this economy.
spenac Posted December 30, 2008 Posted December 30, 2008 Medicare/Medicaid/Insurance look for anything that indicates that the patient could have traveled by any other means besides ambulance. If it appears that they could have payment is denied or is at least decreased. Non payment leads to low EMS wages. So all the non paying patients does affect you.
Christopher.Collins Posted December 30, 2008 Author Posted December 30, 2008 So heres another one... who decides when not to pay? Is it just a bunch of pencil pushers with a flip chart of criteria? If so is it at the very least backed by accredited physicians?
spenac Posted December 30, 2008 Posted December 30, 2008 Your companys billing service reads your report and then uses pre established billing codes. If the codes are payable you get paid. Sometimes billing companys stretch what you said to make it meet payable criteria. Also many billing companys break the law by giving a list of things to say or not say in your report. I do not lie by direct statement or omission. Honestly most claims that do not meet the criteria never leave the billing companys office unless they need a denial in order to be able to bill the patient directly.
Eydawn Posted December 30, 2008 Posted December 30, 2008 I got to sit with my billing folks as part of my orientation. Guess what Medicare paid out on a $1700 chest pain bill? $375. Yep, that's it. What they do is minimize cost wherever possible... that's why this little form called the Advance Beneficiary Notice (ABN) exists for us to have patients sign if we feel that Medicare may not pay for their transport. You want to go to the hospital that's 20 miles further out when the one right here meets your "level of medical need"? Sign the ABN- Medicare doesn't pay for extra mileage. Medicaid is even worse... they tend to pay out less, and if you have a patient who qualifies for both Medicare and Medicaid, you CANNOT legally bill them for the balance. Surprise! Every little thing you check on your PCR, from pulse ox to nasal cannulas to IV starts... equates to a billing code with a set cost for that service. And yes, if your patient is WALKING to the ambulance, according to Medicare, they could have WALKED to a taxicab and therefore it was a superfluous transport so they don't have to pay out for it. That's the logic. Does it suck? You bet it does. I put "assisted patient to cot/pram/ambulance" because you bet I'm assisting them to walk, sit down, get comfortable, climb into the ambulance, etc. because I don't want them to fall while in my care. It sucks. But it's what we have to do to ensure we stay around to provide treatment to people. Wendy CO EMT-B
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