We Are Not Billers.

I know this sounds naive, but I don't know of a single road medic I worked with that actually knew how much we billed or what qualified for what. Either the MD/RN signed the PCS or they didn't.

Paperwork was never falsified, and our billing department expected that we accurately document the patient's condition and treatment.

Surely there are other services out there that have the same expectations of employees.
 
MMiz said:
I know this sounds naive, but I don't know of a single road medic I worked with that actually knew how much we billed or what qualified for what. Either the MD/RN signed the PCS or they didn't.

Paperwork was never falsified, and our billing department expected that we accurately document the patient's condition and treatment.

Surely there are other services out there that have the same expectations of employees.
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When I worked IFT we were told what counted as medicare fraud (falsified PCS from the facility with the EMS report just parotting that so medicare paid, among other things), and were expected to be accurate in documenting and if neccessary turn down transports that would get us in trouble
 
This is an issue I have been wondering about for a long time. I work for an IFT service and frequently get patients where the necessity for transport forms are incorrect, and I don't know how to handle it, or how the billing side of it even works.
 
jtpaintball70 said:
When I worked IFT we were told what counted as medicare fraud (falsified PCS from the facility with the EMS report just parotting that so medicare paid, among other things), and were expected to be accurate in documenting and if neccessary turn down transports that would get us in trouble
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If I get a dispatch that originates from a hospital, they should know better than to request a transport for a patient that doesn't need it, and they are required to give us a medical necessity form, which is usually signed by the doctor, and which details why they need the transport. Only in a few cases however have I ever thought there was NO reason the patient needed us. In those cases I make sure the medical necessity form is filled out completely, which puts everything on the hospital requesting the transport, not on me.
 
Transport is usually set up by the social worker who has never even seen the patient. We get a "bedconfined" patient who is walking around the room. Medical necessity is also filled out by the social worker most times (The "discharge planner" is so conviently never defined by medicare so it includes anybody from the social worker to the LPN who couldn'[t previously sign) or nurses who don't care even when you tell them the patient's walking around as they check "bed confined"
 
Veneficus said:
Is it so easy to tell people if they cannot afford help they are not going to get it?
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To build off of this...

It's the inevitable debate. Is it so easy to tell patients they can't get help because the funding has run out for their procedure?

Is it easy to tell patients that so and so product or drug is no longer available because the government funding ran out.

Is it so easy for hospital staff to tell their families that they will have to start scraping by because there isn't enough money for wages?

There will never be an unlimited amount of money to pay for health care, regardless of who's funding it. There are pros and cons about single payer, unregulated insurance markets, and heavily regulated insurance markets. The question will never be "how can everyone get the health care they want" but "who is going to get screwed and who can be blamed for it."
 
On the flip side - there are cases where a patient is concerned about costs, and I don't have the answers to their questions. As much as I hate it, I run the party line about "Billing isn't my department"
 
Veneficus said:
That is modest.

I have seen dead people who got bills for $20,000 worth of attempted resucitation. With a hospital that pursued the estate for it.
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We don't bill dead people.

And the way my corps does it, we send the bill three times. If you don't pay it after the third bill, we drop it. I've had people not want to go because they can't afford it (ie don't have insurance), and we tell them to just ignore the bill and it'll go away. This is for patients who I think would do better going to the hospital than sitting around at home dealing with their ailment. But we're a volunteer department, so I'm sure we do things differently than the paid guys.
 
Maybe your company doesn't, but a lot of companies send that bill to the family!
 
emt seeking first job said:
IMHO, you are not responsible for someone's financial health.
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When providing a fee for service, shouldn't there be some concept of how much that fee would be?

Your physician isn't responsible for your financial health, so would you ask him how much he charges before you set up an appointment?
 
JPINFV said:
When providing a fee for service, shouldn't there be some concept of how much that fee would be?

Your physician isn't responsible for your financial health, so would you ask him how much he charges before you set up an appointment?
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I would ask the office.

I admit, it is a tough issue, the one nice thing about my vollie is we never charge, even people's insurance and we even transport home.
 
JPINFV said:
When providing a fee for service, shouldn't there be some concept of how much that fee would be?

Your physician isn't responsible for your financial health, so would you ask him how much he charges before you set up an appointment?
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Simple answer is No.

Long answer is it depends. If patient have medicare and/or medicare insurance he/she do not care how much it cost. If person have private insurance they also do not care as they will pay deductible/co-payment/ reduce amount that insurance company decide company should make. That leaves those that pay out of pocket. Those patient need to agree to cost prior to be transported.
 
When hospitals discharge people, some at least, have social workers that review the person's sitaution. This includes ability to pay.

Some people have family getting them.

Some do not.

When I worked in operations at a hospital, I was not directly involved, but I heard of social workers getting coverage somehow, a grant, or just funds from the hospital to buy people clothes, get them transport home, and in some cases a Greyhiund ticket home if they were out of town and somehow ended up in the insititution and had no $ to get home.

It should not come down to the EMT providing transport to have to break it to the person.

The EMT monitors their vitals and gets them to their bed.
 
In San Diego. *ALL* Emt's b's and p's are required to know billing. Though, many do not. It is in the front of the protocol book under the "Patients Bill of Rights".
 
I don't handle, we have billing specialists who handle that. If someone asks on a 911 calls if they will receive a bill, my normal response is "if you are having a medical emergency and need to go to the hospital, a bill should be the least of your worries."

on a non-emergency transport, I tell patients I don't handle billing. But we provide a service, and you should expect some fee for a service.

the concept of a free ride or a free service (without being tax funded) is one of the reasons we have such a hard time making any money to pay employees a decent salary.
 
DrParasite said:
I don't handle, we have billing specialists who handle that. If someone asks on a 911 calls if they will receive a bill, my normal response is "if you are having a medical emergency and need to go to the hospital, a bill should be the least of your worries."

on a non-emergency transport, I tell patients I don't handle billing. But we provide a service, and you should expect some fee for a service.

the concept of a free ride or a free service (without being tax funded) is one of the reasons we have such a hard time making any money to pay employees a decent salary.
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The trouble with the bolded line above is that for the person with no medical education, they really do not always know what's a medical emergency that justifies a big bill or whether the problem can wait for a PCP visit, or maybe it's not even a problem at all.

It's a bit like you, noticing a stain on the carpet, call the carpet guy who comes out and tells you that you could very easily have a major carpet problem, and you could either replace the carpet, have him steam clean the whole thing with his van-based machine, or you could scrub the carpet yourself with a spray can from the grocery store. The carpet guy, if he properly analyzed the stain, could probably tell you which one would work, and if his company trusted his analytical abilities they'd maybe let him tell you what he really thought. Oh, and the cost? "Well ma'am, if you have a bad stain on your carpet and need it taken care of, the bill should be the least of your worries."

It's a far-fetched analogy at best, but it illustrates how limited we make ourselves, out of a failure to properly address ALL of the needs of the patient, their need for education, for financial stability, and for emergency medical care.
 
Generally a patients abiloty to.pay should not enter our minds. But when you are doing a bs discharge and you know that insurance wont cover their txp, dont we as advocates have the duty to inform our patients that they will be responsible for the $500 bill out of pocket?
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The issue isn't with the family who called or the service you provide. Its with the people doing the discharge who felt they needed to go by ambulance.

Part of our job is to be patient advocates informing them of a bill isn't doing them any favors if you still transport them. I see what your trying to do, but your not going to help them informing them of this new unexpected cost they just incurred. They don't know why they have to go by EMS, they just are discharged and want to go home.

Tracking down the person who called you, explaining why the patient is getting stuck with a bill and giving them an alternative option (NEV transport?) is what you need to be doing. I've done it before and Ill do it again. Ive walked off units with our stretcher and no patient after talking with the social worker and having them call our dispatch to set up alternative transportation. Most of the people who do handle the discharges are sympathetic to the patient and will be happy to work with you if you can give them an alternative. Plus your employer will be happy to get something rather than nothing (if the person doesn't pay).

Telling them they are getting a bill is only being considerate but your still part of the problem. As you said its a BS discharge so why are you being part of the problem instead of the solution and working on behalf of the patient?
 
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