ALS1 question

[Ying]

So the LA County do not need to follow the CMS definition?

 

[DesertMedic66]

So the LA County do not need to follow the CMS definition?

What definition would that be?

If it was the one that was stated before then they should.

It would probably be easier if you tell us what happened and what was billed or how it was billed. At this point in the conversation it would be easier.

 

[Ying]

What definition would that be?

If it was the one that was stated before then they should.

It would probably be easier if you tell us what happened and what was billed or how it was billed. At this point in the conversation it would be easier.

Pretty simple, one BP and finger glucose check billed ALS1.

 

[luke_31]

What definition would that be?

If it was the one that was stated before then they should.

It would probably be easier if you tell us what happened and what was billed or how it was billed. At this point in the conversation it would be easier.

Don't think they are interested in giving the whole story. My guess is it's the patient, a lawyer, or the paralegal trying to get the patient out of paying their bill.

 

[DesertMedic66]

Pretty simple, one BP and finger glucose check billed ALS1.

Here, I will make it even easier to understand. At anytime was there a paramedic on scene?

 

[Ying]

Here, I will make it even easier to understand. At anytime was there a paramedic on scene?

911 was called due to nausea and vomiting. After BP and glucose check, transferred to a hospital. Then billed ALS1. That is the whole story.

 

[DesertMedic66]

911 was called due to nausea and vomiting. After BP and glucose check, transferred to a hospital. Then billed ALS1. That is the whole story.

So you got a medic and they did an assessment. That is all that is required for ALS1.

 

[Ying]

So you got a medic and they did an assessment. That is all that is required for ALS1.

Go back to the previous question: only an ALS crew was qualified to perform the ALS1 assessment . BP and finger glucose can be checked by anyone. So no ALS1 assessment was performed here.

 

[Jim37F]

BP and finger glucose can be checked by anyone

Nope. In Los Angeles County, EMTs explicitly cannot do finger sticks for blood glucose checks. That is an ALS only skill per the LA Co EMS Agency, which overseas ALL prehospital 911 EMS within the county, regardless if it's a fire department rescue ambulance or private ambulance IFT.

Yes any Tom, Duck or Harry can buy a meter from Rite Aid...but once you summon 911, the EMTs and Paramedics that respond are legally bound to their scope of practice, which says only a paramedic can do this particular skill.

 

[DesertMedic66]

Go back to the previous question: only an ALS crew was qualified to perform the ALS1 assessment . BP and finger glucose can be checked by anyone. So no ALS1 assessment was performed here.

How many times do we have to tell you, it does not matter exactly what kind of assessment was done as long as it was done by a paramedic. As another poster already pointed out in LA county EMTs are not allowed to check glucose levels. So by your own logic/bias or whatever else is the issue here, you have a paramedic who did an assessment and checked a blood glucose level (which can not be done at the BLS level in LA). That makes that ALS crew qualified to preform the assessment.

I’m just going to leave it at that. Multiple people have shown you and explained to you that this call can be billed at the ALS1 level. So if you are trying to get out of paying for it or something else along those lines you are going to have an uphill battle.

 

[Chimpie]

Hopefully all posts on this topic are now in this thread. All questions and opinions about this situation should remain here. Thanks!

 

[Ying]

How many times do we have to tell you, it does not matter exactly what kind of assessment was done as long as it was done by a paramedic. As another poster already pointed out in LA county EMTs are not allowed to check glucose levels. So by your own logic/bias or whatever else is the issue here, you have a paramedic who did an assessment and checked a blood glucose level (which can not be done at the BLS level in LA). That makes that ALS crew qualified to preform the assessment.

I’m just going to leave it at that. Multiple people have shown you and explained to you that this call can be billed at the ALS1 level. So if you are trying to get out of paying for it or something else along those lines you are going to have an uphill battle.

Easy, easy.
CMS definition is there.

 

[Tigger]

How many times do we have to tell you, it does not matter exactly what kind of assessment was done as long as it was done by a paramedic. As another poster already pointed out in LA county EMTs are not allowed to check glucose levels. So by your own logic/bias or whatever else is the issue here, you have a paramedic who did an assessment and checked a blood glucose level (which can not be done at the BLS level in LA). That makes that ALS crew qualified to preform the assessment.

I’m just going to leave it at that. Multiple people have shown you and explained to you that this call can be billed at the ALS1 level. So if you are trying to get out of paying for it or something else along those lines you are going to have an uphill battle.

Nobody can show how CMS would accept that, because they will not. It has nothing to do with your local scope of practice.

 

[DesertMedic66]

Nobody can show how CMS would accept that, because they will not. It has nothing to do with your local scope of practice.

It has to do with who responded and what kind of an assessment was done. For a 911 call (here) you automatically get a paramedic and that paramedic automatically preforms an assessment which is considered ALS. That is all the criteria needed to bill at ALS1. To bill at ALS2 requires additional interventions/medications aside from just an assessment.

Why would CMS not accept it (aside from paperwork not being correct)?

 

[ParamagicFF]

911 was called due to nausea and vomiting. After BP and glucose check, transferred to a hospital. Then billed ALS1. That is the whole story.

If you wanted the cheapest ride to the hospital then you should have taken the bus.

The ALS assessment is more expensive because of the knowledge and scope of the assessment, not only the interventions. Your bill coincides with services rendered. Don't like the service, don't use it.

 

[Tigger]

It has to do with who responded and what kind of an assessment was done. For a 911 call (here) you automatically get a paramedic and that paramedic automatically preforms an assessment which is considered ALS. That is all the criteria needed to bill at ALS1. To bill at ALS2 requires additional interventions/medications aside from just an assessment.

Why would CMS not accept it (aside from paperwork not being correct)?

You can can bill for an ALS assessment but that does not necessarily increase it to the ALS1 rate. Sending an ALS unit for a transfer does not guaranetee an ALS rate nor should it.

@BillingSpecialist could you clarify? As you stated earlier I believe, there is no way a BGL should trigger an ALS bill even if a paramedic performed the assessment.

 

[DesertMedic66]

You can can bill for an ALS assessment but that does not necessarily increase it to the ALS1 rate. Sending an ALS unit for a transfer does not guaranetee an ALS rate nor should it.

@BillingSpecialist could you clarify? As you stated earlier I believe, there is no way a BGL should trigger an ALS bill even if a paramedic performed the assessment.

Except the CMS clearly states that all that needs to be met to bill ALS1 is: have a call that requires a paramedic and that paramedic has to do an ALS assessment. There are no definitions of what an ALS assessment is. In my system an ALS assessment literally means any assessment that was performed by a paramedic reguardless of what he/she actually assessed.

 

[DrParasite]

Go back to the previous question: only an ALS crew was qualified to perform the ALS1 assessment . BP and finger glucose can be checked by anyone. So no ALS1 assessment was performed here.

Did a paramedic perform the assessment? did they do a BGL check, which LA county says BLS can't perform? Did they transport the patient to the hospital?

Based on the CMS criteria, which was posted previously, it seem pretty clear that they met the criteria for an ALS1 billing.