Defining EMS for our Communities-Facility Education
Last Week…
In this space last week, we advocated stepping out to educate our communities about EMS. We focused primarily on where to educate people on the subject of when it’s appropriate (and not appropriate) to call 9-1-1 in light of medical necessity and the need for EMS.
Our goal in making these suggestions was to assist you in getting the word out to the public in an effort to minimize the amount of runs we all must take where the patient could have easily been transported for treatment by another mode of transportation.
Not all 9-1-1
However, for many EMS organizations not all of your call volume is 9-1-1 in nature. For many of us, a large portion of the ambulance transports that we participate in originate from health care facility requests.
These transports are inter-facility in nature, including discharges, single trip patient re-locating and/or round trip transports for outside care and treatments not available at the sending facility. The transports can be life-threatening in nature such as hospital-to-hospital transfers of severely ill or injured patients to facilities with a higher level of care or they can be routine, non-emergent in nature for patients who require the services of a diagnostic or therapeutic specialty facility.
They cover a wide range of needs.
CMS Ombudsman Request
Thanks to the influence of the American Ambulance Association, we learned via e-mail this week that the Ombudsman for the Center for Medicare and Medicaid Services (CMS) requested a meeting with the AAA in an effort to reduce denials for non-emergency ambulance services that originate in health care facilities.
The AAA and the Ombudsman office agreed, following their meeting, that it was of extreme importance that health care facilities become better educated on Medicare’s coverage requirements for ambulance transports. The consensus was reached as it was identified that facility representatives play a huge role in requesting these services, yet often do not fully understand when ambulance transport is appropriate and when it is not.
Facility Guidance Document
To meet the need for education, the AAA has developed a useful guidance document that you can present to facility staff and administrators to help them better understand Medicare’s guidelines for coverage of ambulance services. It is the hope of both CMS and the AAA (and all of us too) that this document will give facility personnel guidance on making appropriate transportation requests and therefore cut down on the number of non-covered ambulance transports which, in turn, will help patients avoid paying out-of-pocket for ambulance services.
By determining if another form of transportation is more appropriate at the time of the request, the end result will be patients and their families who will be less burdened with bills for ambulance transports where Medicare will most likely deny coverage.
The document is available for download from the Internet at:
http://www.the-aaa.org/downloads/Position%20Papers/7-3-13%20Facility%20Guidance.pdf
We Suggest
We suggest you do the following…
- First, download this document, today!
- Read it, digest it, understand it. Be ready to explain it.
- Identify the facilities you serve and schedule a meeting with their administrators
- Request a time to provide staff education (you’ll be surprised how open they will be to your request!)
- Identify key staff members who can benefit from this education (no need to meet with the cleaning people, it’s the discharge planning people you need to get in front of.)
- Develop a short video or PowerPoint presentation to spice things up a bit (DON’T go into a meeting and read the AAA document word-for-word- they can do that themselves. Highlight the key points and stress the concepts behind the document.)
- Put together other handouts that may be useful before you meet.
- When you meet, consider these suggestions…
- Take some of your key staff members along. Do a meet and greet at the same time. Develop relationship with these important business sources.
- Take along some equipment. Help facility staff understand the “toys” you work with, what they cost, how they play a role.
- Let them walk outside and see the ambulance. Help them understand what you do.
- Splurge for a few munchies. Make it fun!
You hold the key…
You hold the key to making this thing work. The AAA has provided you with a nice, working document. CMS has basically invited you to join in the dialogue.
Now, act!
Instead of sitting around grumbling about the fact that Medicare doesn’t pay, turn the negativity into positivity and get out there and educate. I think you’ll be surprised at how you’ll be welcomed in most facilities and the after-affects can be outright huge for your department.
Keep us Posted!
Let us know how your education efforts go. We’d love to hear from you after you’ve met regarding the success of such meetings.
Clients… if we can assist you in any way by providing background or information for your presentations, let us know. Consider putting together a short synopsis of the impact payment denials have on your department.
Don’t be afraid to share your frustrations and your goals to improve your department and always express how your ultimate goal is to lessen the stress for your patients. Everyone can identify with that common goal, be it facility or ambulance department.
Not a client?
If your billing office or outsourcing contractor isn’t educating you to get the message out, how can you be equipped to further educate the facilities you serve? It’s probably time to check us out. We’re more than just a billing company. We’re a resource for our clients and a partner in the ambulance industry’s overall success.
