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

[Bullets]

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?

Yeah, it's been requested that I explain and the court said I have no obligation. Only to provide the material. I'm not a lawyer so I didn't question it further

 

[JPINFV]

Yeah, it's been requested that I explain and the court said I have no obligation. Only to provide the material. I'm not a lawyer so I didn't question it further

...and you don't find this unethical at all?

 

[kaisardog]

document, document,...

as a retired lawyer , EMT b and former assistant DA, I can tell you that the more accurate documentation you have , the better off you are when you are called to testify about something 5 years after it happened. if what was written is unclear to the supervisor reading your report, it is perfectly legal, and 'ethical' for him/her to ask you to make a further (truthful) explanation. (and perfectly legal to fire you if you refuse to do so...) if some patient decides to sue everyone on the transport for assault and battery, you may be glad that you were made to add documentation clearly explaining why the pt was 'unable to sign..'
... and here in my state a CNA, like my sister, is a certified nurse-anesthetist, who not only has an RN 4 year college degree but also a year more of nursing education and advanced certification and training in anesthesia administration .. which makes a CNA a higher level of training than most emt b' s or paramedics..

 

[chaz90]

... and here in my state a CNA, like my sister, is a certified nurse-anesthetist, who not only has an RN 4 year college degree but also a year more of nursing education and advanced certification and training in anesthesia administration .. which makes a CNA a higher level of training than most emt b' s or paramedics..

Brief aside from the main topic of this thread.

This reference to a CNA is to a Certified Nursing Aide (or Assistant). It's a roughly month long course geared mainly towards care of patients in long term care facilities, patient hygiene, and vital sign checks. Totally different thing than your sister, who is a highly trained CRNA (Certified Registered Nurse Anesthetist).

 

[VFlutter]

\
... and here in my state a CNA, like my sister, is a certified nurse-anesthetist, who not only has an RN 4 year college degree but also a year more of nursing education and advanced certification and training in anesthesia administration .. which makes a CNA a higher level of training than most emt b' s or paramedics..

:rofl: You are missing a letter in there. CRNA is a Certified Registered Nurse Anesthetist, CNA is a Certified Nurse Assistant.

And a one year CRNA program? Where do I sign up???

 

[MrJones]

... and here in my state a CNA, like my sister, is a certified nurse-anesthetist, who not only has an RN 4 year college degree but also a year more of nursing education and advanced certification and training in anesthesia administration .. which makes a CNA a higher level of training than most emt b' s or paramedics..

...and here in my state a CNA is a certified nursing assistant who has less training and responsibilities than an EMT.

 

[JPINFV]

...and here in my state a CNA is a certified nursing assistant who has less training and responsibilities than an EMT.

EMTs and CNAs fighting over who's better?

 

[ffemt8978]

Time to get back on topic, please.

 

[Medic496]

Puts

Since EMS only makes one way, putting bodies on gurneys and driving to medical care, we must justify the transport. 911 does not need to justify medical necessity as much as private industry doing transport. In the world of documentation, if it wasn't documented, it wasn't done. A company cannot collect on a bill in which there is no verification of PUTS. No paychecks prevent EMT's from showing up to work. Obtain your PUTS and help your company succeed!

 

[Christopher]

Since EMS only makes one way, putting bodies on gurneys and driving to medical care, we must justify the transport. 911 does not need to justify medical necessity as much as private industry doing transport. In the world of documentation, if it wasn't documented, it wasn't done. A company cannot collect on a bill in which there is no verification of PUTS. No paychecks prevent EMT's from showing up to work. Obtain your PUTS and help your company succeed!

"PUTS"? This is not a common acronym.

We're 911 and our paychecks are not based on billing incomes (granted they're certainly helped by it), so we're not interested in documentation to support billing beyond the required datapoints for NEMSIS. Pretty much the only billing related requirement is a signature from the patient/guardian in accordance with CMS rules.

I'm certain this is different from interfacility transports, but our crews are instructed to document appropriate patient care for the sake of an appropriate continuation of care...not so we can rack up big billing dollars. That would be unethical.

 

[JPINFV]

I'm certain this is different from interfacility transports, but our crews are instructed to document appropriate patient care for the sake of an appropriate continuation of care...not so we can rack up big billing dollars. That would be unethical.

How is documenting accurately for billing unethical?

 

[Christopher]

How is documenting accurately for billing unethical?

This was more in reference to the poster's statement that the company's financial incentive to keep your job should drive documentation. I find this to be a perverse incentive. If appropriate documentation of patient care is not adequate for billing...one wonders what they're being asked to "add" to make it appropriate.

Perverse incentives are a known issue in human factors ("organizational factors").

 

[VFlutter]

This was more in reference to the poster's statement that the company's financial incentive to keep your job should drive documentation. I find this to be a perverse incentive. If appropriate documentation of patient care is not adequate for billing...one wonders what they're being asked to "add" to make it appropriate.

There is a section of our charting that has a place to put how many infusion pumps/arms that we are using. Apparently they use that for billing and other documentation. No one ever remembers to fill in those boxes.

So for example you may write something like "Patient is on Heparin, NS, Propofol, and Fentanyl drips. Vancomycin administered on route". That is great for continuation of care but does not help billing if they do not know how all that was ran. They may ask you to add an addendum saying "One Alaris pump with 4 channels used, Each drip ran through separate channel. Vancomycin piggy backed with Normal saline primary." I do not see anything wrong with that.

 

[Christopher]

There is a section of our charting that has a place to put how many infusion pumps/arms that we are using. Apparently they use that for billing and other documentation. No one ever remembers to fill in those boxes.

So for example you may write something like "Patient is on Heparin, NS, Propofol, and Fentanyl drips. Vancomycin administered on route". That is great for continuation of care but does not help billing if they do not know how all that was ran. They may ask you to add an addendum saying "One Alaris pump with 4 channels used, Each drip ran through separate channel. Vancomycin piggy backed with Normal saline primary." I do not see anything wrong with that.

With the way our charting works this would be a non-issue for us as you have no choice but to enter them in separately and if you used a pump for each (although I'm not sure we'd include make/model of pump, this has little relevance outside of QA/QI of device failures...but I'm sure nobody records lot numbers of lancets or SAM splints).

 

[NomadicMedic]

I think a bigger issue is medical necessity for the transport. I worked for an interfacility company that would require you to specify the patient's medical necessity. For example, "patient cannot tolerate a wheelchair" is not a medical necessity however, "patient has a large stage four decubitus ulcer on her left buttock and requires special positioning on ambulance stretcher" Or "patient is an aspiration risk, requires special positioning and continuous suction during transport". EMTs would frequently leave the medical necessity line blank or fill-in something like "patient called ambulance". They were asked to write an addendum to make the billing portion complete.

I see no issue with this at all.

 

[usalsfyre]

This was more in reference to the poster's statement that the company's financial incentive to keep your job should drive documentation. I find this to be a perverse incentive. If appropriate documentation of patient care is not adequate for billing...one wonders what they're being asked to "add" to make it appropriate.

Perverse incentives are a known issue in human factors ("organizational factors").

Errr.....have you ever dealt with Medicare/caid?

 

[Carlos Danger]

This was more in reference to the poster's statement that the company's financial incentive to keep your job should drive documentation. I find this to be a perverse incentive. If appropriate documentation of patient care is not adequate for billing...one wonders what they're being asked to "add" to make it appropriate.

Perverse incentives are a known issue in human factors ("organizational factors").

I doubt there are any perverse incentives. Not on the part of the billing office, anyway.

The problem is that insurers will deny a claim for any stupid tiny reason they can find, and they intentionally look for excuses to do so. A favorite "reason" for claim denial is "lack of documentation supportive of the claim".

The only way to avoid this is for the documentation to be so R-I-D-I-CU-L-O-U-S-L-Y clear that the insurer couldn't possibly argue that the claim is unsupported. Since most of us don't write in such a manner, management probably finds it easier to just require an addendum that restates the critical points in such a a way that it can't be refuted.

 

[JPINFV]

This was more in reference to the poster's statement that the company's financial incentive to keep your job should drive documentation. I find this to be a perverse incentive. If appropriate documentation of patient care is not adequate for billing...one wonders what they're being asked to "add" to make it appropriate.

Provided that what is being asked is something that the provider has the appropriate training to document and isn't lying, does it matter? Furthermore, the company's financial incentive is my financial incentive. If the company doesn't make money, than it closes down and I subsequently don't make money.

 

[Christopher]

Errr.....have you ever dealt with Medicare/caid?

Yep, and it usually came down to (for us at least) signature related issues. The rest seem to have gone away with electronic charting and detailed QA/QI. I'll say it again, if you're documenting your patient care appropriately you should have no trouble billing (on the 911 side).

Perhaps paper charts or other ePCR systems just aren't well suited to presenting the necessary information to your billers.

 

[Christopher]

I doubt there are any perverse incentives. Not on the part of the billing office, anyway.

The problem is that insurers will deny a claim for any stupid tiny reason they can find, and they intentionally look for excuses to do so. A favorite "reason" for claim denial is "lack of documentation supportive of the claim".

The only way to avoid this is for the documentation to be so R-I-D-I-CU-L-O-U-S-L-Y clear that the insurer couldn't possibly argue that the claim is unsupported. Since most of us don't write in such a manner, management probably finds it easier to just require an addendum that restates the critical points in such a a way that it can't be refuted.

There is a fine line between "restating the critical points" to force an insurer to pay and retooling documentation to improve billing rates. One is clarification and one is fraud.