I'm a bit of a policy wonk, and doing research for a paper... so pouring through medicare payment documentation, and hundreds of pages of dense rules... fun, no?
Right now, i'm working through the Medicare Benefit Policy Manual (Chapter 10 for those interested).
Here we have talked about the myriad of benefits of not transporting working codes (dangers of driving while performing compressions [without an auto pulse-like device], relative uselessness of ACLS, etc.) and electing to phone a doc and declare on scene. I read that many progressive services and state protocols now call for deceleration of death (at the prerogative of the medic nand medical control doc) after so many minutes of ineffective rhythms on scene. I hear and see all of this.
Then I read medicare rules, which just encourage me to jump off a high building. Many of us work for private services that while sometimes progressive, are ultimately focused on unit efficiency and above all billing. See the below statement:
So... clever and knowledgeable friends, what are your experiences with this? Do you know of departments who's protocols allow for field pronouncements, but company policies prohibit? What does your billing department say about spending an hour on scene, giving a few rounds of meds, shocks, etc, declaring death, then leaving (and not billing)? Are things any different for third-services or fire departments?
Am I missing something here? Are you aware of services protesting this section, or movements for alternate policy? Do you agree with this policy? What incentives do services have not to transport a working code (albeit dangerously for crew), despite the known futility, just in order to bill?
Policy-makers out there, how do we discourage this practice (if you think it's wrong)?
Feel free to comment privately (via PM if you wish), especially if you're willing to share company policies or documents.
Thanks!
Right now, i'm working through the Medicare Benefit Policy Manual (Chapter 10 for those interested).
Here we have talked about the myriad of benefits of not transporting working codes (dangers of driving while performing compressions [without an auto pulse-like device], relative uselessness of ACLS, etc.) and electing to phone a doc and declare on scene. I read that many progressive services and state protocols now call for deceleration of death (at the prerogative of the medic nand medical control doc) after so many minutes of ineffective rhythms on scene. I hear and see all of this.
Then I read medicare rules, which just encourage me to jump off a high building. Many of us work for private services that while sometimes progressive, are ultimately focused on unit efficiency and above all billing. See the below statement:
10.2.6 - Effect of Beneficiary Death on Medicare Payment for Ground Ambulance Transports
(Rev. 103; Issued: 02-20-09; Effective Date: 01-05-09; Implementation Date: 03-20-09)
Because the Medicare ambulance benefit is a transport benefit, if no transport of a Medicare beneficiary occurs, then there is no Medicare-covered service. In general, if the beneficiary dies before being transported, then no Medicare payment may be made. Thus, in a situation where the beneficiary dies, whether any payment under the Medicare ambulance benefit may be made depends on the time at which the beneficiary is pronounced dead by an individual authorized by the State to make such pronouncements.
The chart below shows the Medicare payment determination for various ground ambulance scenarios in which the beneficiary dies. In each case, the assumption is that the ambulance transport would have otherwise been medically necessary.
So... clever and knowledgeable friends, what are your experiences with this? Do you know of departments who's protocols allow for field pronouncements, but company policies prohibit? What does your billing department say about spending an hour on scene, giving a few rounds of meds, shocks, etc, declaring death, then leaving (and not billing)? Are things any different for third-services or fire departments?
Am I missing something here? Are you aware of services protesting this section, or movements for alternate policy? Do you agree with this policy? What incentives do services have not to transport a working code (albeit dangerously for crew), despite the known futility, just in order to bill?
Policy-makers out there, how do we discourage this practice (if you think it's wrong)?
Feel free to comment privately (via PM if you wish), especially if you're willing to share company policies or documents.
Thanks!