Question about HIPAA

WVNobody

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So this morning we get dispatched for a non-emergent transport from a nursing home to a psychologist appointment. I was asking the off going crew for directions and my supervisor was telling me how to get there and said that we needed to take a wheelchair because they don't like stretchers in the office. I said okay and he said to make sure we take the patient inside before we transfer the patient from the stretcher to the wheelchair. I asked why and he said that apparently it is a HIPAA violation to transfer a patient from a stretcher on the sidewalk. I didn't think it was and honestly don't see how it could be.. He didn't either... I tried googling it and couldn't find much on it.

What does everyone here think?
 

MonkeyArrow

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Definitely not a HIPPA violation, no information is being used or even in question here. Its probably more of a patient privacy and/or safety thing not to be "exposing" your patient needlessly or not staying on the sidewalk to where things could roll away or you have more of a chance of getting hit by something/someone.

If I had to guess, I would probably think he meant to help preserve your patient's modesty, and just used HIPAA as the broad spectrum medical privacy nomenclature, even though its not accurate here.
 

akflightmedic

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That and the fact that this could be fraudulent billing practice by the ambulance service. If you said you were in CA I would say this is definitely the case, but rampant transport fraud could take place in WV too.

If the patient is wheelchair capable, why was he not sent in a non-medical wheelchair van? Instead a BLS stretcher unit charge now applies...
 

LACoGurneyjockey

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That and the fact that this could be fraudulent billing practice by the ambulance service. If you said you were in CA I would say this is definitely the case, but rampant transport fraud could take place in WV too.

If the patient is wheelchair capable, why was he not sent in a non-medical wheelchair van? Instead a BLS stretcher unit charge now applies...
Before I escaped the ems purgatory of dialysis transfers and doctors appts, it was explained to me that they can be transferred to a wheel chair and sit in it alone, as long as they could not stand up or walk to it without assistance Medicare would still pay it. The idea was a wheelchair van will not lift the patient if they can't stand unassisted. But it's all fraudulent billing there.
For the OP, not a HIPAA violation. But it's just good practice to do things inside when you can. There's AC, and less people to see if/when I drop the patient on their *** :D
 

RedAirplane

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The Hippa says hello. :)
 

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RedAirplane

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It may be a privacy issue but I don't think it's a HIPPA issue, although to be fair, I'm not a lawyer and have no particular desire to comb through a tedious piece of legislation that is in fact bigger than the cute pink guy I posted above.

Now that the issue of EMS taking people to doctors appointments has come up, here's a question: regardless of the call, you're supposed to do an assessment (I think?). Suppose you're taking someone for their weekly/daily psychotherapy. Wouldn't the patient get pretty annoyed at having a full exam done every single time, just to go from home to the office and then going back? Head to toe, CSM, vital signs, pupils, asking all the question again...
 
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WVNobody

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I didn't see how it was an issue either. I did see how it could possibly be a safety issues but not a privacy issue. I just wanted to see what everyone else thought.

I don't really want to get into discussing medical necessity because it is currently in question. But my particular service has very few wheelchair vans and what not so the patient will a lot if times be loaded onto a stretcher and transported along with a wheelchair and once at the facility will be transferred back to their wheelchair. These are billed the same as a wheelchair van I do believe.
 

akflightmedic

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Interesting concept. Higher demand for wheelchair vans but not enough so use the more expensive EMT staffed ambulance....and continue to bill at lower wheelchair van rates. Hmmm.... :)
 

LACoGurneyjockey

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Interesting concept. Higher demand for wheelchair vans but not enough so use the more expensive EMT staffed ambulance....and continue to bill at lower wheelchair van rates. Hmmm.... :)
It's better than having a unit post with no calls holding, from a strictly business point of view.
 

akflightmedic

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From a business perspective it is pending failure, poor utilization of resources and piss poor management.

It would seem the business model should focus on acquiring more wheelchair vans since that is where the demand is so you do not use the higher cost units on lower revenue events...that is, unless you are billing at the higher rate (fraudulently).
 

DieselBolus

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One of the Medicare criteria for BLS vs WC transport is that they are unable to sit erect for the duration of the transport. I appreciate the creativity in using a BLS rig as a WC van though.

There are plenty of patients who spend all day every day in a wheelchair that would be unable to support themselves bouncing down the road in a wheelchair van. It takes a good amount of core strength to stay upright in a moving wheelchair and this can be very exhausting to someone in poor physical health. The retention system for the wheelchair isn't necessarily very rigid, and sitting on floppy pieces of vinyl that make up the seat and back is nothing like a normal seat.

If this patient is making weekly trips to the doctor, it may very well be pre-authorized as many scheduled trips are.
 

akflightmedic

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Very familiar with the criteria...all comes down to documentation. "Patient placed on stretcher" as opposed to "patient assisted to stretcher"...words can be damning and delay or deny payment. Using a BLS rig is not creative, scale of economics (if we are still speaking within business perspective only).

If the decision is altruistic and made with patient comfort in mind...kudos. However, my skepticism is high in this regard.
 

Chewy20

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It may be a privacy issue but I don't think it's a HIPPA issue, although to be fair, I'm not a lawyer and have no particular desire to comb through a tedious piece of legislation that is in fact bigger than the cute pink guy I posted above.

Now that the issue of EMS taking people to doctors appointments has come up, here's a question: regardless of the call, you're supposed to do an assessment (I think?). Suppose you're taking someone for their weekly/daily psychotherapy. Wouldn't the patient get pretty annoyed at having a full exam done every single time, just to go from home to the office and then going back? Head to toe, CSM, vital signs, pupils, asking all the question again...

Treat the call, not the book. Not every patient needs a full physical. A patient calls 911 (for some reason) because he smashed his finger in a car door, you show up and palpate his entire body and check his pupils? Why?

To the OP, not a HIPPA violation.
 

DesertMedic66

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Treat the call, not the book. Not every patient needs a full physical. A patient calls 911 (for some reason) because he smashed his finger in a car door, you show up and palpate his entire body and check his pupils? Why?

To the OP, not a HIPPA violation.
I check pupils on all patients...
 

JPINFV

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Interesting concept. Higher demand for wheelchair vans but not enough so use the more expensive EMT staffed ambulance....and continue to bill at lower wheelchair van rates. Hmmm.... :)
Loss leader.

Also see hospitals taking medicare patients.
 

akflightmedic

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That is a significant loss leader when done on regular basis as I am quite familiar with the concept. It is a loss loser unless there is significant quantity (see hospitals taking medicare patients). If there is a regular significant quantity, then the focus on more appropriate vans would be best...unless, again there was ulterior motive.
 

Akulahawk

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When I was doing those transfers, we would occasionally have the BLS units take wheelchair patients. However, we'd only do that if our wheelchair vans were too busy. We'd bill at the W/C rate when we did that. There's certainly a lower profit margin doing this though. Doing those transfers from stretcher to wheelchair out on the sidewalk certainly doesn't help patient privacy, but it's not a HIPAA violation.

I must say, however, that we used the standard W/C forms when doing those runs so that we couldn't bill for BLS vs. W/C.
 
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