Documentation & Reimbursement

Documentation & Reimbursement
Documentation has many important uses besides reimbursement.  It is the legal record for your agency and for your patients, is shared with hospitals to provide continuity of care and is used for internal data collection and quality assurance.  Over the next few months, our newsletter will feature a series of articles on documentation from the billing perspective.  This first installment is focused on the dispatch information that is crucial to billing.

Part 1:  Dispatch

Let's start with the "How" of dispatch.  To be considered an emergency transport, Medicare has 2 requirements:  1) the dispatch must be through a 911 or equivalent system and 2) the response must be immediate.  This means the PCR needs to describe HOW you were dispatched and HOW you responded, even if 100% of your calls come through 911.

This information can be documented in the narrative section, for example, "Dispatched emergency ALS for difficulty breathing, responded immediately to residence at 123 Elm St".   Using software that has a section for dispatch information with response times and response level also documents this information.

If the patient condition at dispatch requires an ALS emergency response but the transport is later downgraded to BLS, you are allowed to bill an ALS assessment.  To qualify as an ALS assessment, Medicare has 3 documentation requirements:  1) it must be an emergency transport; 2) the patient's reported condition at dispatch required an ALS crew and 3) ALS crew performed a hands-on assessment.  The dispatch information is crucial to be able to bill at the ALS level.

Now let's look at the "When" and "Where" in dispatch information.  Dates and times are always important, especially when there are multiple transports on the same day.  Submitting a claim with an incorrect date can result in a denial.  If we are able to see that the date on the PCR is incorrect, we will ask for an amended report.

The point of pick-up sets the rate that Medicare will pay for the transport. The zip code of the pick-up location must be included on the PCR to document whether the transport should receive an urban, rural or super-rural bonus.  If the point of pick-up is a facility such as a hospital or dialysis center, include the facility name in the PCR.

Keep in mind that the PCR is the main source to prove which services were provided-and proof equals payment!

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