ALS Billing Question

lacey15890

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We do a routine transfer of a patient who requires diastat to go with for precaution, and because of that we have to send an ALS unit. We have yet to have to administer any medication and our crew members are arguing that they should chart the run BLS. Our argument is that regardless of how we will ultimately bill it, it was called in ALS, they do an ALS assessment and Als was required for precautionary measures, they should document the run the way it was ran. Are we wrong in our way on thinking? Should we be marking down these ALS runs when there are no ALS interventions or would the ALS assessment rule apply here making this run ALS billable?
 

Remi

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This is a good example of just one of the many things wrong with CMS.

I don't know all the ins and outs of the medicare rules for ambulance billing, but my understanding is that if an "ALS assessment" (whatever that means) is done and charted, then the run can be billed as an ALS run. No IV needs to be started and no meds need to be administered. But the run needs to be charted that way in order to bill the higher ALS rate, which is why your company insists it be charted as an ALS run even though nothing ALS-ey was done.

So is it important to chart it as an ALS run? Yes, if you want your company to be able to bill a higher rate. Is it legal to do so? Probably. It is fiduciarily responsible for CMS to pay a higher rate for routine transport of a patient who requires no special care, just because the patient carries a medication than any layperson can give if needed?
 

NPO

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, but my understanding is that if an "ALS assessment" (whatever that means) is done and charted, then the run can be billed as an ALS run.
This may soon be changing, for Medicaid at least.
The latest update to my states Medicaid reimbursement policies requires ALS Assessment AND ALS intervention.
 

Tigger

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We do a routine transfer of a patient who requires diastat to go with for precaution, and because of that we have to send an ALS unit. We have yet to have to administer any medication and our crew members are arguing that they should chart the run BLS. Our argument is that regardless of how we will ultimately bill it, it was called in ALS, they do an ALS assessment and Als was required for precautionary measures, they should document the run the way it was ran. Are we wrong in our way on thinking? Should we be marking down these ALS runs when there are no ALS interventions or would the ALS assessment rule apply here making this run ALS billable?
Is this a routine transfer with a PCS? If it is physician ordered ALS transfer with a PCS that reflects the possible need for an ALS medication to be administered, than you could probably bill ALS (I think). I am not sure you can bill ALS assessment on a scheduled transfer either.

The most recent guidance we received on ALS assessment was that it billable so long as an "ALS dispatch complaint" was recorded. Yes, this doesn't make much sense. But, given this guidance from our billing company and a variety of billing folks that came to our region to do a finance conference, if it's a Charlie level call or above (or P2/P1 if that's how your system works), and a paramedic provides an "ALS assessment," it could be billed ALS. Otherwise, unless an ALS intervention is performed, it goes BLS.
If the order is for an ALS rig then it’s billed as an ALS run.
You can bill whatever you want as ALS, that doesn't mean CMS will pay it as such. CMS routinely only pays out BLS rates on transfers that the facility sends as ALS if no ALS care is provided. Unfortunately, how a transfer is requested has almost no bearing on how billing works. The only possible exception is for emergent transfers to a higher level of care that do not need a PCS form.
 

CCCSD

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Requiring ALS equipment, that can’t be operated by BLS, makes it an ALS billing, since it’s an ALS Crew.
 

Tigger

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Requiring ALS equipment, that can’t be operated by BLS, makes it an ALS billing, since it’s an ALS Crew.
Possibly, if it is physician ordered that way and the chart was written explaining that the patient is at risk seizures and requires constant monitoring for said condition and the ability to treat it. I have no idea what the basis for this transfer is (routine for dialysis, radiation, something else), but if the crew just documents a typical transfer with no mention of the above condition, it isn't going to get paid ALS, regardless of what the PCS says. Every transfer we take is sent "ALS" by the hospital because they think that's important, our reimbursement certainly does not match this.
 

CCCSD

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The original post specified ALS crew with ALS equipment. Ergo: ALS call, even if no ALS intervention was needed AT THE TIME of the transport.
 

Peak

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We do a routine transfer of a patient who requires diastat to go with for precaution...
Requiring ALS equipment, that can’t be operated by BLS, makes it an ALS billing, since it’s an ALS Crew.
A BLS crew cannot administer diazepam. I agree that it is therefore ALS, if it's documented in a way that supports that is another matter.
 

Tigger

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The original post specified ALS crew with ALS equipment. Ergo: ALS call, even if no ALS intervention was needed AT THE TIME of the transport.
And again, this does not mean you will be reimbursed at an ALS rate for it. You can bill whatever you want, if the documentation doesn't support it, which could easily occur in this case, CMS will doubtless downcode it.
 

johnrsemt

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Company I used to work for transported a pediatric patient 88 (or 98) miles (paid for 88 miles, faster to go the 98 miles by about 3 minutes, more scenic to go the shorter route): who had a bad habit of seizing: but the protocol that we had just for him was not to treat for the seizure unless they lasted for more than 10 minutes; and not to divert to a different hospital for any reason. Really got nerve wracking to transport a child seizing for 25 plus minutes who had 10mg Plus of Valium on board with no relief and you still had 20 minutes of heavy traffic to get to the hospital.
We were transporting him for dialysis to the children's hospital and they were the only place who would touch him because of his seizures. When I moved he was 14 years old and weighed 51 lbs. He was born with no kidneys. He had 1 transplant, new kidney had lasted 6 months.

If a seizure lasted less than 7 minutes he had NO postictal state afterward, if he seized while he was singing along with a CD, he would stop seizing and start singing where he left off; and stop and say "I had a seizure that lasted _ seconds long {he always knew within a few seconds due to how much song he missed}.
We had fun arguing with our Medical Director about the lack of postictal state: Medical Director wouldn't believe us for almost 2 years, so I finally challenged him to come ride with us sometime. so he did. Patient was nice enough to seize about 8 times that morning, a few lasting over 5 minutes. Doctor was surprised, and argued with a lot of other doctors about that in the future.
Always transported with a medic on board, but usually transported and charged BLS. unless he seized longed than 10 minutes and the medic had to take over patient care (we usually drove).
Usually there is no such thing as ALS assessment: we didn't put him on a monitor: we did vital signs, mom checked his sugar just as we got to the house from his dialysis port and we put him on SPO2 monitor; he would only let us do a couple of BP's unless he didn't feel well then he would let us do more. We didn't usually argue with him.
Really interesting thing is he had a stroke at about 15 years old and his left side was totally flaccid, no arm or leg control. But when he had a seizure the 1st 30-60 seconds he would clench his arms up tight to his chest (both arms) you couldn't pull them down if you tried; and it the seizure went longer than 60 seconds it would go full blown grand mal., But he couldn't move his left arm if he wasn't seizing. They couldn't figure that out at the hospital.

Transporting him 6 times a week, I could do his paper work in my sleep, and thinking about it, I could still probably do it, and it has been almost 11 years since the last time I transported him
 
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