ALS1 question

[Ying]

Simple question: if there is only one blood pressure check and one finger glucose check plus transportation, can this be billed for ALS1 in Los Angeles?

 

[luke_31]

Simple question: if there is only one blood pressure check and one finger glucose check plus transportation, can this be billed for ALS1 in Los Angeles?

This should be directed to the county EMS agency or call the service that transported you and question them. Most of us are providers and not responsible for billing, which can be specific to an area or depends on insurance, i.e. There are a multitude of factors that go into billing that can't really be properly addressed on a anonymous forum.

 

[Ying]

ALS1 Definition: Advanced life support, level 1 (ALS1) is the transportation by ground ambulance vehicle (as defined in section 10.1, above) and the provision of medically necessary supplies and services (as defined in section 10.2, above) including the provision of an ALS assessment by ALS personnel or at least one ALS intervention.

Advanced Life Support Assessment Definition: An ALS assessment is an assessment performed by an ALS crew as part of an emergency response (as defined below) that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment.

With those definitions, BP and finger glucose check dose not qualify for ALS assessment. So, it should not be billed as ALS1. Am I right?

 

[luke_31]

ALS1 Definition: Advanced life support, level 1 (ALS1) is the transportation by ground ambulance vehicle (as defined in section 10.1, above) and the provision of medically necessary supplies and services (as defined in section 10.2, above) including the provision of an ALS assessment by ALS personnel or at least one ALS intervention.

Advanced Life Support Assessment Definition: An ALS assessment is an assessment performed by an ALS crew as part of an emergency response (as defined below) that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment.

With those definitions, BP and finger glucose check dose not qualify for ALS assessment. So, it should not be billed as ALS1. Am I right?

This is a legal question which is requiring a interpretation and this site doesn't allow for legal advice.

 

[DesertMedic66]

ALS1 Definition: Advanced life support, level 1 (ALS1) is the transportation by ground ambulance vehicle (as defined in section 10.1, above) and the provision of medically necessary supplies and services (as defined in section 10.2, above) including the provision of an ALS assessment by ALS personnel or at least one ALS intervention.

Advanced Life Support Assessment Definition: An ALS assessment is an assessment performed by an ALS crew as part of an emergency response (as defined below) that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment.

With those definitions, BP and finger glucose check dose not qualify for ALS assessment. So, it should not be billed as ALS1. Am I right?

If a paramedic preformed an assessment and the call was deemed to need a paramedic response then it can be billed as ALS by your criteria.

 

[Ying]

But ALS assessment can only performed by qualified ALS crew according to the definition. BP and finger glucose can be performed by anyone. So, BP and finger glucose should not included in ALS assessment.

 

[DesertMedic66]

But ALS assessment can only performed by qualified ALS crew according to the definition. BP and finger glucose can be performed by anyone. So, BP and finger glucose should not included in ALS assessment.

As I stated before, if there was a paramedic on scene who did an assessment (doesn’t matter what they treated or assessed as long as it was a paramedic) and the call information required a medic to respond then it’s ALS. Forget about a glucose check and a single set of vitals. The ONLY 2 things that are needed are what I stated above.

If I go to a lawyer and talk directly to him about paperwork then I will be charged at his rate. Even if his legal secretary could have easily done that I will still be charged at his rate.

 

[Jim37F]

But ALS assessment can only performed by qualified ALS crew according to the definition. BP and finger glucose can be performed by anyone. So, BP and finger glucose should not included in ALS assessment.

In LA, BLS CANNOT do a finger stick BSG. That is an ALS procedure according to LACoEMSA.

Not saying it never happens that medics hand the kit over to an EMT to do the finger stick because it is so stupidly simple and literally over the counter for diabetics everywhere...but per LA Co, it's still "invasive" and therefore an ALS procedure outside the scope of an EMT.

 

[BillingSpecialist]

Simple question: if there is only one blood pressure check and one finger glucose check plus transportation, can this be billed for ALS1 in Los Angeles?

I'm not 100% sure on the protocols in California, but blood pressure check and finger glucose check should not qualify for an ALS transport. There needs to be ALS procedures done in order for it to be considered an ALS Transport.

 

[DrParasite]

Simple question: if there is only one blood pressure check and one finger glucose check plus transportation, can this be billed for ALS1 in Los Angeles?

Being in Los Angeles has nothing to do with it....

provided a paramedic conducted the assessment, and they completed the requirements to perform an ALS assessment, than you can bill as ALS1 as per the CMS.

per from Page 7 of CMS, section 30.1.1:

Advanced Life Support, Level 1 (ALS1) Definition: Advanced life support, level 1 (ALS1) is the transportation by ground ambulance vehicle (as defined in section 10.1, above) and the provision of medically necessary supplies and services (as defined in section 10.2, above) including the provision of an ALS assessment by ALS personnel or at least one ALS intervention.

Advanced Life Support Assessment Definition: An ALS assessment is an assessment performed by an ALS crew as part of an emergency response (as defined below) that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. In the case of an appropriately dispatched ALS Emergency service, as defined below, if the ALS crew completes an ALS Assessment, the services provided by the ambulance transportation service provider or supplier may be covered at the ALS emergency level, regardless of whether the patient required ALS intervention services during the transport, provided that ambulance transportation itself was medically reasonable and necessary, as defined in section 10.2, above.

@BillingSpecialist , do you agree?

 

[BillingSpecialist]

Being in Los Angeles has nothing to do with it....

provided a paramedic conducted the assessment, and they completed the requirements to perform an ALS assessment, than you can bill as ALS1 as per the CMS.

per from Page 7 of CMS, section 30.1.1:

Advanced Life Support, Level 1 (ALS1) Definition: Advanced life support, level 1 (ALS1) is the transportation by ground ambulance vehicle (as defined in section 10.1, above) and the provision of medically necessary supplies and services (as defined in section 10.2, above) including the provision of an ALS assessment by ALS personnel or at least one ALS intervention.

Advanced Life Support Assessment Definition: An ALS assessment is an assessment performed by an ALS crew as part of an emergency response (as defined below) that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. In the case of an appropriately dispatched ALS Emergency service, as defined below, if the ALS crew completes an ALS Assessment, the services provided by the ambulance transportation service provider or supplier may be covered at the ALS emergency level, regardless of whether the patient required ALS intervention services during the transport, provided that ambulance transportation itself was medically reasonable and necessary, as defined in section 10.2, above.

@BillingSpecialist , do you agree?

Yes I agree!

 

[Ying]

But in the ALS definition, it says that only an ALS crew was qualified to perform the assessment. BP and finger glucose can be checked by anyone. I think if EKG or something only a certified crew can do, it could account for ALS1.

 

[Ying]

Thank you so much for your reply.

 

[luke_31]

But in the ALS definition, it says that only an ALS crew was qualified to perform the assessment. BP and finger glucose can be checked by anyone. I think if EKG or something only a certified crew can do, it could account for ALS1.

Not true as some localities don't allow an EMT to check a blood sugar and it also depends on what the call was dispatched as. I think you are confusing the actual procedure which anyone can do and once it becomes medical personal how not everything that laymen can do is allowed by protocol. A blood sugar is considered an invasive procedure which EMTs in all localities are not permitted to do. Los Angeles county doesn't allow EMTs to perform many procedures that the lay public can do, blood sugar checks is one of them. For Los Angeles county it is an ALS procedure.

 

[DesertMedic66]

But in the ALS definition, it says that only an ALS crew was qualified to perform the assessment. BP and finger glucose can be checked by anyone. I think if EKG or something only a certified crew can do, it could account for ALS1.

It doesn’t matter what kind of assessment they used. As long as an assessment was performed by an ALS provider. So as a paramedic I can arrive on scene of a 911 “ALS level call” and only assess/treat to the BLS level but because I am a paramedic and on a call that required a paramedic response it can be billed ALS.

If John called 911 in my system for toe pain then he will get an ALS ambulance because all 911 calls are deemed ALS response. Because a medic responded and did an assessment it is billed ALS.

If John called my company privately for toe pain then we would send out a BLS ambulance. Because no medic did an assessment it can not be billed ALS.

In both of those scenarios the assessment preformed was the exact same but because of how the call is labeled and who did the assessment, we can bill at different rates.

 

[Ying]

What is the definition of “ALS call”?
All 911 call will be billed ALS?

 

[DesertMedic66]

What is the definition of “ALS call”?
All 911 call will be billed ALS?

That is going to depend on your system. In my system all 911 calls are ALS calls and are billed at the ALS rate because a paramedic reaponds and preforms an assessment.

Any call where it is determined that a paramedic is needed, even if they are not going to do anything special, is an ALS call. So if an urgent care calls our dispatch and says they need a paramedic ambulance then that will be billed at the ALS rate. If that same urgent care calls and states they need a BLS ambulance then that will be billed at the BLS rate. If a hospital sets up an interfacility transport to another hospital and requests a Critical Care Transport then the CCT rate will be billed.

 

[Ying]

Thanks for clear that.

 

[DrParasite]

What is the definition of “ALS call”?
All 911 call will be billed ALS?

My friend, my earlier post defined many of the things you inquiring about, as well as provided you to the link to the government publication which defines exactly what you are looking for.

I encourage you to read it (it's only 12 pages), as it might help clear up much of the confusion you are experiencing.

 

[Jim37F]

I've been on calls in LA Co as an EMT ON A BLS ambulance with a BLS fire engine...and had to call for, and sit and wait on, an ALS Squad with two Paramedics literally just for a BSG check because per LA Co protocols, BSG is "invasive" and outside the scope of practice for EMTs.

So yeah...you have paramedics doing a paramedic only (legally speaking) skill...