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[ebass30920]

I have regular pt. we pick up about 300 times a year. This pt. never needs an ambulance but hey education has not worked for them and Its just part of the gig. Th problem is physicians lie about her condition in order to get an ambulance to take her home. I have no issues going to her house but the physicians know better and do it any way. I absolutely disagree with this getting billed to medicaid/medicare. I am tempted to report this as abuse but I would like insight from everyone here.

 

[JPINFV]

How do you know it is Medicare/cade and not something else, like private pay or a charity case?

 

[ebass30920]

My company will not transport them with out the medical necessity form. I use the hospital face sheet to input the pt. billing info on my PCR. This is a quote from the medicare website: "Abuse occurs when doctors or suppliers do not follow good medical practices that can result in unnecessary costs to Medicare. These practices may result in unnecessary costs to the Medicare Program, improper payment, or services that are not medically necessary."

 

[Veneficus]

I have regular pt. we pick up about 300 times a year. This pt. never needs an ambulance but hey education has not worked for them and Its just part of the gig. Th problem is physicians lie about her condition in order to get an ambulance to take her home. I have no issues going to her house but the physicians know better and do it any way. I absolutely disagree with this getting billed to medicaid/medicare. I am tempted to report this as abuse but I would like insight from everyone here.

I think it was Tennyson who said:

"Theirs not to reason why, theirs but to do or die,"

What if they have a medical issue and have difficulty with transportation. Should they be left at home to suffer or fend for themselves?

What if they have no other way?

What is the reason for necessity given?

If you feel the person doesn't need an ambulance, but the physician does, have you considered asking why?

 

[JPINFV]

Just because the patient has a medical nessity form filled out doesn't necessarilly mean it's getting billed through Medicare. Sure, it's required to bill Medicare, but its presence doesn't automatically mean it will.

What criteria is the hospital using for medical necessity? Bed confinement?

 

[ebass30920]

I am not talking about picking the pt up from home I was referring to taking her home. The issue isn't with the pt. at all its with a provider abusing an already broken system. The reason stated is always "pt. need O2". Today as I rolled her out of the hospital she was singing and sating at 100 percent. I have never seen her on oxygen and I cant see anything in her history that would indicate a need for oxygen.

 

[ebass30920]

Oh sorry I have asked why she needs oxygen and I asked why she wasnt on it in the hospital. I was just ignored. I have worked urban systems for almost five years but this one particular scenario really get under my skin.

 

[Veneficus]

Then you should talk it over with the physician.

If you were ignored, there exists the possibility that EMS providers are not respected enough to warrent a reply.

But just be careful because if the physician ordered oxygen and for whatever reason you didn't provide it, you might be on shaky ground.

 

[CAOX3]

When something had been accepted practice for years its hard to break the cycle.

But there may be a whistleblowers percentage in it for you, however you probably would never get a job in ems again, just document the transport wasn't necessary and be done with it. You made an attempt, it fell on deaf ears, let it go don't make it a personal crusade. From what I hear about some private companies you will end up being the one on the outside looking in.

 

[HotelCo]

... just document the transport wasn't necessary and be done with it. You made an attempt, it fell on deaf ears, let it go don't make it a personal crusade.

I second this.

 

[ebass30920]

I absolutely did my job and documented it as I always do. The more I think about it there really isn't anything I can do. Have always worked busy systems and for me to be bothered by abuse it has to be extreme and this is an extreme case. Although it is wrong I don't think a paramedic will win vs. an MD. Thanks for the replies.

 

[JPINFV]

Here's another question. Who signed it? Was it the physician, the RN, or the discharge planner. Despite the name including the term "physician," there are numerous other people who can fill one out.

 

[ebass30920]

It was signed by the RN and Physician.