Preventing Fraud-"Medical Necessity"

Ginger1

Forum Ride Along
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0
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All this is great. Would anyone be willing to post links to the aforementioned articles? New to the field, undereducated on provider liability, having trouble tracking down the info on my own. Thank you.
 

MunchkinMedic

Forum Crew Member
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2
8
former paramedic turned patient currently on Medicare here

We get these bills and depending on how things are documented, it can make a large difference on what we end up getting a bill for. Where I live in AZ, AMR is the main provider for 911 & IFT, though that’s slowly being encroached on by another company though that’s another topic. I have a Medicare plan that covers medically necessary ambulance transports with a copay of $150. However, my plan does NOT cover any other forms of transportation, leaving me solely responsible for all non medically necessary forms of transportations. I’m on continuous oxygen and although I’m ambulatory for short distances ( from bed to gurney, gurney to bed, or bed to wheelchair and occasional walker under close supervision since I’ve broken 5 or 6 bones when not supervised). Lately I’ve been getting bills for approximately 2K whether it’s from hospital discharge to SNF or ALF when it really should be my $150 copay. I think documentation is most of it, and case managers really not knowing what’s going on since out here, they are the ones arranging transportation
 

johnrsemt

Forum Deputy Chief
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Munchkin;
I found out if an ambulance crew documents that a patient writes in their narrative that a patient walks to cot at all (even standing up from the bed, pivoting and sitting on the cot) then Medicare/Medicaid usually won't pay for the transport.
So I always left that part out, even if they had to walk to the hall or to the living room. Because like you are maybe finding out, it makes a big difference, where I work part time, it can be $6,000 for a transport (110-130 miles to the hospitals).
 

hometownmedic5

Forum Asst. Chief
692
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Munchkin;
I found out if an ambulance crew documents that a patient writes in their narrative that a patient walks to cot at all (even standing up from the bed, pivoting and sitting on the cot) then Medicare/Medicaid usually won't pay for the transport.
So I always left that part out, even if they had to walk to the hall or to the living room. Because like you are maybe finding out, it makes a big difference, where I work part time, it can be $6,000 for a transport (110-130 miles to the hospitals).
So you’re intentionally lying(by omission) so your employer can get paid. Congratulations, you’re part of the problem. Yeah, yeah, I get it. If you do your job clean, you’ll be fired. Self preservation doesn’t negate the offense. If you steal food because your hungry, you still stole food. You shouldn’t face the same penalty as someone stealing a video game, but you’re still a thief.
 

Tigger

Dodges Pucks
Community Leader
6,907
2,002
113
Munchkin;
I found out if an ambulance crew documents that a patient writes in their narrative that a patient walks to cot at all (even standing up from the bed, pivoting and sitting on the cot) then Medicare/Medicaid usually won't pay for the transport.
So I always left that part out, even if they had to walk to the hall or to the living room. Because like you are maybe finding out, it makes a big difference, where I work part time, it can be $6,000 for a transport (110-130 miles to the hospitals).
Or you could just document what you did. There are plenty of other reasons that CMS pays for trips that don't include the stretcher.
 

FirstResponder

Forum Probie
29
9
3
So you’re intentionally lying(by omission) so your employer can get paid. Congratulations, you’re part of the problem. Yeah, yeah, I get it. If you do your job clean, you’ll be fired. Self preservation doesn’t negate the offense. If you steal food because your hungry, you still stole food. You shouldn’t face the same penalty as someone stealing a video game, but you’re still a thief.
probably the best response I've seen
 
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