BLS Non-Emergent Transport of Dialysis Pts and how to justify Medical Necessity

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lacey15890

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Im an EMT-B and now work in the back end billing side of our company. Im trying to balance what I know about the pts personally from transporting them and figure out on the back end if we are actually meeting medical necessity repeatedly for each PCR. What does your company actually require in your NARRATIVE vs just the entire PCR in general? I am NAAC certified as well and still having trouble clarifying our exact needs based on Medicare rules. PLEASE HELP!
 
Your manager should have all that in a policy or legal docs reference section.
 
as long as it's documented somewhere on the PCR, that should suffice; many legal experts (of which I am not one) will tell providers not to duplicate what they write on the front / check boxes of the PCR on the back, because any discrepancy can cause issues later on.

You should probably ask your management what they want in a narrative or PCR, have them write it in a policy, and make sure whatever you need to justify medical necessity is included in that policy.
 
DrParasite said:
as long as it's documented somewhere on the PCR, that should suffice; many legal experts (of which I am not one) will tell providers not to duplicate what they write on the front / check boxes of the PCR on the back, because any discrepancy can cause issues later on.

You should probably ask your management what they want in a narrative or PCR, have them write it in a policy, and make sure whatever you need to justify medical necessity is included in that policy.
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the only hard part there is that our owner/manager is a private owner with no ems back ground. for the most part since i recently received my CAC I have kind of taken charge and am trying to get these things in order. you do not learn much about charting for payment in emt class which is now were we are having the problem. I really just want to get this right
 
might want to check out this page, as it has some leads on where you can get more information on medical billing.

If you want to know what needs to be on a PCR for legal reasons, I suggest contacting your company's attorney for legal advice.

You might also want to ask your boss to consult an expert on medical coding and billing: here are a few I found online

the latter two definitely are not cheap, however they are likely cheaper than medicare fines or criminal charges for medicare fraud.
 
There are 2 of us in the office that are certified ambulance coders which is some 5 day long conference held by PWW but it was more stressed on how to code and get it out the door correctly and only dabbled in documentation requirements we are marking things down when appropriate but with routine dialysis there is a fine line with a few of our repetitives that's hard to determine but I was also previously taught by prior management that everything in your PCR also needs to be in your narrative but it seems so repetitive and gives way for inconsistencies which also worries me plus they are tired of repeating the same thing in 1 PCR sometimes 3 times
 
I would said that the chart and medical necessity forms need to describe... why its medically necessary. You should be saying patient is bed bound but stood amd pivot to stretcher.
 
This document is great, and from a reputable source, in outlining what is needed to document "medical necessity" for medicare, medicaid, and others.
 
lacey15890 said:
Im an EMT-B and now work in the back end billing side of our company. Im trying to balance what I know about the pts personally from transporting them and figure out on the back end if we are actually meeting medical necessity repeatedly for each PCR. What does your company actually require in your NARRATIVE vs just the entire PCR in general? I am NAAC certified as well and still having trouble clarifying our exact needs based on Medicare rules. PLEASE HELP!
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I am going to assume you are talking about medi/medi. My basic advice is to tell your owners it to drop the insurance. Look around the industry, without giving legal advice which is not permitted in this forum I can say that many companies have closed as result of medi/medi action. I would also advice you to look for another job if the owners decide to continue accepting medi/medi. There is no real way to design medical necessity that will satisfy them.

edit:to be specific i am talking about direct patients from medi/medi and not from 3rd party vendors such as Logisticare, National med trans network etc.
 
My department has a policy that we don't transport patients to and from. The only exception is for severe weather when all other options have been exhausted, and our dispatch has verified that the normal transport (non-ambulance) services are unable to provide service.

In these cases we run it as a public assist, and not a billable transport.
 
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