Can upper management/billing force us to write an addendum?

ZootownMedic

Forum Lieutenant
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So I am in a sticky situation guys. We have an owner of our private ambulance company who is trying to run the place and has no understanding of EMS. His highest level of medical training is CNA. Now he is trying to force us to write addendums for pts who are unresponsive or for some other reason unable to sign their consent to transport. He is saying that for EVERY callwe run where a patient is unresponsive or unable to sign we HAVE to write an addendum to the call stating why the patient couldnt sign.....EVEN IF IT WAS ALREADY STATED IN OUR REPORT! Is this legal? Thanks in advance.
 

RocketMedic

Californian, Lost in Texas
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So I am in a sticky situation guys. We have an owner of our private ambulance company who is trying to run the place and has no understanding of EMS. His highest level of medical training is CNA. Now he is trying to force us to write addendums for pts who are unresponsive or for some other reason unable to sign their consent to transport. He is saying that for EVERY callwe run where a patient is unresponsive or unable to sign we HAVE to write an addendum to the call stating why the patient couldnt sign.....EVEN IF IT WAS ALREADY STATED IN OUR REPORT! Is this legal? Thanks in advance.

Redundant, yes, but also quite legal.
 
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ZootownMedic

ZootownMedic

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Can you explain the justification for this? If I am the writer of a report, and it is something that I may have to defend it in court, how can someone who wasn't on the call tell me that I have to add something to it? Thanks
 

Carlos Danger

Forum Deputy Chief
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Can you explain the justification for this? If I am the writer of a report, and it is something that I may have to defend it in court, how can someone who wasn't on the call tell me that I have to add something to it? Thanks

Because he isn't telling you to write something that didn't happen. He's just telling you to re-state very clearly something that you already documented. Why would that be illegal? How would that hinder you if you are ever deposed?

It's just a billing thing. It's annoying, and there should be a more efficient way to convince the insurers that there's a reason the patient didn't sign, but insurers look for any excuse possible not to pay ambulance claims, and a common tactic is simply pretending that the documentation isn't clear enough.

This addendum is just a way to make your documentation crystal-clear to the insurers, therefore making it more likely that your company will have the claim paid in a timely manner.

It's easy, as a field person, to have attitude that "billing isn't my problem", but don't forget where your paycheck comes from.
 
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medicsb

Forum Asst. Chief
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The CCT service I work for will have us write addendums for billing purposes, usually just clarification on whether something occured. For example, I note that pt. was receiving 2lpm O2 via NC, but I forget to click that the O2 was continued for transport. Even though I said all meds/treatments were continued for transport, they want an addendum say that O2 definitely was continued. No big deal, I do the addendum. We operate at a loss every year, so anything that can be done to decrease the loss is a pretty good thing as long as it doesn't harm patients or providers.
 

akflightmedic

Forum Deputy Chief
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It's easy, as a field person, to have attitude that "billing isn't my problem", but don't forget where your paycheck comes from.

Quoted for maximum effect....
 

JPINFV

Gadfly
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So I am in a sticky situation guys. We have an owner of our private ambulance company who is trying to run the place and has no understanding of EMS. His highest level of medical training is CNA. Now he is trying to force us to write addendums for pts who are unresponsive or for some other reason unable to sign their consent to transport. He is saying that for EVERY callwe run where a patient is unresponsive or unable to sign we HAVE to write an addendum to the call stating why the patient couldnt sign.....EVEN IF IT WAS ALREADY STATED IN OUR REPORT! Is this legal? Thanks in advance.


Shrug, every place I've worked had an "Unable to sign box" and a place for justification on the back. Is it really that hard to write an addendum stating "UTS secondary to ALOC"?
 

46Young

Level 25 EMS Wizard
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So I am in a sticky situation guys. We have an owner of our private ambulance company who is trying to run the place and has no understanding of EMS. His highest level of medical training is CNA. Now he is trying to force us to write addendums for pts who are unresponsive or for some other reason unable to sign their consent to transport. He is saying that for EVERY callwe run where a patient is unresponsive or unable to sign we HAVE to write an addendum to the call stating why the patient couldnt sign.....EVEN IF IT WAS ALREADY STATED IN OUR REPORT! Is this legal? Thanks in advance.

This is standard for the business, and is manadtory where I work.
 

mycrofft

Still crazy but elsewhere
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Shrug, every place I've worked had an "Unable to sign box" and a place for justification on the back. Is it really that hard to write an addendum stating "UTS secondary to ALOC"?

Billing weenies (much like I was for two years) don't want acronyms. We wanted/want things like " unable to sign due to----" (head injury, possible metabolic ketoacidosis as evidenced by..., loss of dominant hand, whatever).

Medically, your charting may be fine a far as communicating to the next level practitioners, but not to folks not "belonging to the club" such as patients, lawyers and insurance companies. Use of excessive acronyms starts to leave crevices open for prying billing and legal staff. Acronyms fall into the old saw, "If it felt good, what you just said (or wrote) will get you in trouble".
 

JPINFV

Gadfly
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Billing weenies (much like I was for two years) don't want acronyms. We wanted/want things like " unable to sign due to----" (head injury, possible metabolic ketoacidosis as evidenced by..., loss of dominant hand, whatever).

Medically, your charting may be fine a far as communicating to the next level practitioners, but not to folks not "belonging to the club" such as patients, lawyers and insurance companies. Use of excessive acronyms starts to leave crevices open for prying billing and legal staff. Acronyms fall into the old saw, "If it felt good, what you just said (or wrote) will get you in trouble".


If the "billing weenies" came up to me and said, "Hey, Joe, could you right "unable to sign due to altered mental status?" I'd respond "Sure" and write, "Unable to sign due to altered mental status." It's neither any significant extra work nor is the argument over acronyms worth having at all. I'm all for choosing your battles and I can't think of a single reason to die on that hill.

At most, I'd ask why the company uses it since, looking at the run sheet (yes, I have a blank copy of my old company's run sheet... shut up/stop laughing), the box on the front is labeled "PUTS" and the section on back uses it (title of box is "Patient unable to sign (UTS)" and it contains "Reason patient is UTS: ____________.").
 

mycrofft

Still crazy but elsewhere
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If the "billing weenies" came up to me and said, "Hey, Joe, could you right "unable to sign due to altered mental status?" I'd respond "Sure" and write, "Unable to sign due to altered mental status." It's neither any significant extra work nor is the argument over acronyms worth having at all. I'm all for choosing your battles and I can't think of a single reason to die on that hill.

At most, I'd ask why the company uses it since, looking at the run sheet (yes, I have a blank copy of my old company's run sheet... shut up/stop laughing), the box on the front is labeled "PUTS" and the section on back uses it (title of box is "Patient unable to sign (UTS)" and it contains "Reason patient is UTS: ____________.").

Sounds perfect.
I had a copy or two of my old blank run sheets for a while too.
 

Akulahawk

EMT-P/ED RN
Community Leader
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It's one thing for admin/billing to ask you to write an addendum to clarify a point. That's not changing the content of what you wrote or the facts behind what you wrote. It's something entirely different for admin/billing to have you re-write the content of your report via addendum and change the substance of that content for billing purposes. That's fraud.

If I was asked to clarify why a person is unable to sign, I'm more than happy to detail why. If I'm told to state that the patient was on oxygen therapy and the patient actually wasn't, then I'm going to refuse and absolutely will NOT write the addendum, and I'll advise my partner NOT to write an addendum either.
 

mycrofft

Still crazy but elsewhere
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Wait until/if you get subpoenaed to clarify some of your charting. No bueno.
 

Tigger

Dodges Pucks
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So I am in a sticky situation guys. We have an owner of our private ambulance company who is trying to run the place and has no understanding of EMS. His highest level of medical training is CNA. Now he is trying to force us to write addendums for pts who are unresponsive or for some other reason unable to sign their consent to transport. He is saying that for EVERY callwe run where a patient is unresponsive or unable to sign we HAVE to write an addendum to the call stating why the patient couldnt sign.....EVEN IF IT WAS ALREADY STATED IN OUR REPORT! Is this legal? Thanks in advance.

As has been stated, it's silly and redundant but perfectly legal.

As for your owner, don't be so quick to judge just because he doesn't have the training you expect. My previous company was owned by a guy that built and ambulance service that was widely regarded as the best in the region from his limo and car wash service. Before AMR bought it out it was the largest privately held ambulance service in the country, and the owner never set foot in an ambulance as far as I know.
 

Bullets

Forum Knucklehead
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Wait until/if you get subpoenaed to clarify some of your charting. No bueno.

This, if i have clearly stated it in my chart, that should be good enough
All of our records are admisable in court, so be careful what you write, if you want to make special notes, use a code only you know

When i work patrol, i write my notes on the officer copy in german shorthand. If requested i must give that copy to the court if the defendant goes to trial, but i have no obligation to translate.
 

JPINFV

Gadfly
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This, if i have clearly stated it in my chart, that should be good enough

...because the people who employ you make it a required part of your employment. How about this, if payment is denied based on you not wanting to fill out an additional box, it's deducted from your pay. I don't (well... won't) get paid if I futz up billing over righteous indignation over writing a sentence.


When i work patrol, i write my notes on the officer copy in german shorthand. If requested i must give that copy to the court if the defendant goes to trial, but i have no obligation to translate.

...and it's cheap little gimmicks like this which makes people hate police officers. What are you trying to hide? Seriously. You're preparing to deprive someone of their life, liberty, or property by accusing them for breaking the law. Instead of providing a fair trial, you hide your notes, and for what? A notch on your belt? A higher conviction rate? That's not justice, that's insanity.
 
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usalsfyre

You have my stapler
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When i work patrol, i write my notes on the officer copy in german shorthand. If requested i must give that copy to the court if the defendant goes to trial, but i have no obligation to translate.

Are you sure about that? If asked when called as a witness you wouldn't have to translate or at least state what the notes are written in?
 

broken stretcher

Forum Crew Member
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If I were you i would write everything you are told to write and add the line somewhere that "this addendum was added as per the orders of supervisor xyz"
 

Wheel

Forum Asst. Chief
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Are you sure about that? If asked when called as a witness you wouldn't have to translate or at least state what the notes are written in?

Or they would google translate, or find one of the many people who speak German
 

JPINFV

Gadfly
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If I were you i would write everything you are told to write and add the line somewhere that "this addendum was added as per the orders of supervisor xyz"

All of the progress notes at my hospital have a line at the bottom that states "I have read/discussed the Patient's Care Plan and agree with the plan. Physician signature _______" and the attending physicians will dictate any changes to the residents/students.

Granted, it's a teaching hospital, but 2nd+ year residents are fully licensed physicians, but even the interns will write and sign their own orders for inpatients.
 
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