Dear EMS Professional,

The OIG recognizes the importance of maintaining a positive and interactive communication between billing companies and the providers they service. Compliance is and always has been of the utmost importance. EMS is difficult. It carries a lot of liability and emphasis has been placed on the fact that you cannot hide behind your billing company. Documentation begins with you and it is an intricate part of “patient care”. You do not want to bill a patient because there was inappropriate documentation.

Presently, there are a lot of audits and investigations being conducted based on data collected from the carriers and the Office of the Inspector General of Health and Human Services. One of the items that can trigger an audit may be an unusually high rate of ALS versus BLS transports in comparison to national percentages. The top ten SCT providers in an area have been targeted. A strong focus in 2018 will be on claims sent to Medicare Part B when the patient is a Part A stay. This is something your call intake person should determine or the squad should ask the question at the facility. As always, patient signatures and PCS (physician certification forms) are a high-risk area for audits.

In an effort to best educate all of our clients regarding agency documentation practices and responsibilities, MCA has formed an alliance with Maggie Adams of EMS Financial Services. Formerly a senior consultant with Page, Wolfberg & Wirth, Maggie has over 20 years of experience as a key contributor in developing and delivering educational training for EMS throughout the nation. You will find a link below to participate via webinar in one of Maggie’s prerecorded documentation training sessions. You will also find a printout attached to this email to hand out to your staff. MCA highly recommends that this be mandatory training for all staff members at your agency.

When you use the link provided (below), you will fill in some information and the time you spend watching it will be logged. The same will be true of your crew members. This should be helpful in providing you a record of who viewed the material.

Training link: https://attendee.gototraining.com/96df3/recording/9067510057348751618

You can download the handout at the link below.

MCA Documentation Essentials Handout

Please be sure to contact MCA directly with any questions, comments or concerns related to this message.

Tara G. Vosler, CEO

The post EMS Financial Training first appeared on EMS Billing - Medical Claims Assistance.

Click on the link below to see updated signature requirements for Medicare

sigsheetinstructions

The post Updated Signature Requirements first appeared on EMS Billing - Medical Claims Assistance.

Tonya Chang with the American Heart Association is looking for personal stories and known instances where individuals in their communities have been saved by bystander CPR (before EMS arrived on the scene). They are looking for individuals who would be willing to share their story in support of their CPR-in-schools legislative initiative, which the Kentucky Ambulance Providers Association is supporting.

If you have a personal story or know of someone who would be willing to share their story, please forward that information to Tonya Chang (Tonya [dot] Chang [at] heart [dot] org) or Tom Adams (director [at] boydems [dot] com).

The post A Request from KAPA first appeared on EMS Billing - Medical Claims Assistance.

You can find this story here… Aging Ambulances

The post REPOST: Are Aging Ambulances Putting You At Risk? first appeared on EMS Billing - Medical Claims Assistance.

Community paramedic visits people before they need 911 again

REPOSTED from HeraldNet.com, Thursday, September 18, 2014

By Eric Stevick, Herald Writer

EDMONDS – At 89, Rosemary Walters looks forward to Shane Cooper’s visits.

Their banter is rapid-fire and frequently funny.

Her mind is sharp.  It is her body that is wearing down.

Walters walks with the aid of two canes.  She has osteoarthritis of the spine and arthritis in her hands, an irregular heartbeat and diabetes.  Her morning routine includes swallowing 16 pills that are lined up on the arm of her easy chair.  More are taken throughout the day.

Senorita Nena, her slightly chubby chihuahua, trained to use scent to detect dangerous changes in Walters’ blood chemistry, stays close by.

The World War II British Army veteran likes it when the man in the dark blue uniform stops by her first-floor Edmonds condominium to check on her.

“He knows how to talk to the old folks,” she said.  “He doesn’t talk down to us.”

Cooper has an unusual job:  He is a community-based paramedic.  Unlike his peers at Snohomish County Fire District 1, he doesn’t respond to emergencies.  Instead, he roams south Snohomish County visiting people with serious medical problems before they need to call 911 again.

He has been at it for eight months now.  His boss thinks Cooper is the first community paramedic working for a fire department in the state.

What Cooper has is the luxury of taking time.  That’s not an option during a typical emergency call, when patients are panicked and seconds count.

“Now there is a conversation,” he said.

With Walters, he discusses a three-hour visit and assessment she had with a social worker.  He asks her daughter, Bryce Durst, if she is making progress with paperwork that will enable Durst to get paid for the around-the-clock care she’s providing.

Cooper checks the swelling in Walters’ legs and ankles.  They talk about the many medicines she is taking, her blood sugar levels and the time of day those levels are being recorded.

Mainly, he’s making sure she’s following her doctor’s orders.

Walters desperately wants to stay put in her cozy home, which has a bookshelf bulging with hard-bound classics.  Too many of her friends have died in nursing homes, she said.

“You want to keep your independence for as long as you can,” she said.

Walters also doesn’t want to be perceived as a chronic complainer.

That’s the beauty of the paramedic who makes house calls before there is a problem, her daughter said.

“It really has been a godsend,” Durst said.  “Mom tends to downplay a lot of the issues.”

Walters is one of an ever-changing number of people on Cooper’s case load.  Earlier this week, the list totaled 155.  Each is designated a row on a 38-column spreadsheet he maintains.

Initially, most of his stops were at homes with the district’s most frequent 911 callers.  That has changed.  Now the lion’s share are referrals from other paramedics and firefighters who have identified people in need of follow-up.

There’s a mix of patients.  Many have fallen.  Some have dementia or mental illness.  Others report weakness, breathing problems, or seizures.

Ideally, Cooper’s roster will be in constant flux.  A big part of his job is to connect patients to other professionals, including nurses and social workers.

“I think it’s going to take all three of us working together,” Fire District Capt. Shaughn Maxwell said.  “There is obviously a gap we are filling.  We want to route them to the right professionals.”

“Our challenge is how to keep up with the demand,” he added.  “How do we sustain this?”

Fire District 1 spent years researching successful community paramedic programs in Australia, Europe, and Canada.

The Verdant Health Commission, an offshoot of the Snohomish County Public Hospital District No. 2, found merit in the fire district’s vision.  It’s providing $144,426 annually over two years to get the program off the ground.

“It certainly seems to be reaching the goals of providing direct support to people with high needs,” said George Kosovich, Verdant’s director of programs and community investments.

It also is highlighting unmet medical needs in the community, which is important for Verdant so it can better understand where it fits in and how it can help, he said.

The job of monitoring the effectiveness of the community paramedic program falls to Robin Fenn, research manager with Snohomish County Human Services.

Initial results – though taken from a small sample of cases – are promising, she said.

She compared 13 patients who could be tracked for three months before and after the community paramedic began in January.  They accounted for 61 emergency medical calls beforehand and 23 after – a 62 percent reduction.  The patients’ emergency room visits also dropped by 54 percent.

“It is hard to track saved dollars,” Maxwell said.

Other fire departments in Snohomish County and beyond are now asking about the Fire District 1 experience.

“There is a lot of interest, a lot of passion, but not much money,” Fenn said.

A key factor in the success of the program is the personality of the paramedic, Maxwell said.

The bottom line is they must be patient and good listeners.

After visiting with Walters last Thursday afternoon, Cooper dropped in on Julia Williams in north Edmonds.

The fire district first began visiting the two-story home when Williams’ mom, who has dementia, took a fall.  She eventually was placed in a Shoreline rehab center.

It became apparent that Williams, 71, also needed help.

That afternoon, she asked Cooper to interpret one of her mother’s medical bills.

They talked about the need to sell the house and what could be done with its contents.

Making house payments has become increasingly stressful – “like keeping the Titanic floating,” Williams said.

Williams reported that she had an assessment scheduled with a psychologist the next day.

As he was preparing to leave, Cooper reviewed his notes.

“So I’m going to give you a buzz in the morning,” Cooper said.

“To keep me from going off the deep end,” she replied, with a smile.

Cooper did call to remind her of her appointment and later followed up to make sure she went.

He makes a lot of follow-up calls.

If patterns continue, his list of patients will grow.

There’s plenty of hidden need in a fire district of 225,000 people.

“It would be nice to replicate me by three,” he said.

Eric Stevick:  425-339-3446; stevick [at] heraldnet [dot] com

©2014 The Daily Herald Co., Everett, WA

Repost of original article located here

The post Community Paramedicine in Washington state first appeared on EMS Billing - Medical Claims Assistance.

The American Ambulance Association submitted this request to all members (related to previous KAPA post)…

Ask Your Congressperson to Co-Sponsor Medicare Relief and Reform (HR 5460) 

September 16, 2014

AAA ACTION ALERT

To: AAA Membership

From:  Jimmy Johnson, AAA President

Re: Ask your Congressperson to Co-Sponsor Medicare Relief and Reform (HR 5460)

This week, several Members of Congress introduced legislation critical to all of those in the ambulance industry. But we NEED YOUR HELP to ensure this bill gets the attention it deserves. Will you please ask your U.S. Representative to co-sponsor H.R. 5460?

H.R. 5460, the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2014, will modernize Medicare ambulance policies, address fraudulent conduct, and make critical stopgap funding a permanent part of the payment system.

Click here to learn more about the legislation and to send an email to your elected official. While we have provided a sample email that you can use, I highly recommend that you edit it by personalizing your message with an example of why you think the legislation is necessary.

Please Note: If you are represented by any of the following members of Congress, please thank him for his leadership on this critical industry issue: Greg Walden (OR-02), Peter Welch (VT-01), Devin Nunes (CA-22) and Richard Neal (MA-01).

Please send your co-sponsor request now. It only takes two minutes of your time. Thank you in advance for making sure our voices are heard on Capitol Hill.

Jimmy Johnson

The post Call to action from AAA first appeared on EMS Billing - Medical Claims Assistance.

From Kentucky Ambulance Providers Association…

H.R. 5460, the Medicare Ambulance Access, Fraud Prevention, and Reform Act  was introduced in the House yesterday afternoon by Congressmen Walden, Neal, Nunes and Welch.

The American Ambulance Association has been meeting with Congressman Walden and members of the House Ways and Means Committee, and they have also met with the offices of Congressmen Roskam, Blumenauer, and Becerra. They are receiving very positive feedback about the bill and hope to secure several key sponsors.

Congressional offices need to hear from their constituents before they agree to cosponsor.

We are asking our KAPA members to contact your member of Congress and ask them to cosponsor this bill. There is a very small window for adding cosponsors before Congress adjourns again for the November elections. Currently, September 23 is the estimate for when Congress will adjourn.

Please visit https://www.govtrack.us/congress/members/KY for help identifying your Congressmen and ways to contact them.

Thank you!

The post Important request from KAPA first appeared on EMS Billing - Medical Claims Assistance.

State-specific restrictions, Medicare reimbursement, turf battles and public and patient acceptance must be tackled for any program to be successful

By Cate Lecuyer, EMS1 Editor

EMS may sit at the kids’ table of health care, but the industry still gets to eat.

“We may not be the biggest player, but we’re a substantial player,” Page, Wolfberg & Wirth attorney Stephen R. Wirth said Wednesday during his session “Shedding Light on the Dark Side of Community Paramedicine” at the ZOLL Summit 2014 tradeshow in Denver.

“There needs to be an ‘us’ mentality,” he added.

As EMS agencies nationwide are gearing up to deliver mobile integrated health care through a community paramedicine model, roadblocks such as state-specific restrictions, Medicare reimbursement, turf battles and public and patient acceptance have emerged as critical aspects that must be tackled in order for any program to be successful, he said.

The good news is that under the Affordable Care Act, there’s a federal incentive and support from the Inspector General for hospitals to reduce readmission rates to avoid being penalized, and it opens the door to experimental community paramedicine programs with that aim.

Getting around the red tape

In 2011, Minnesota was the first state to pass a community paramedicine statute that includes Medicaide coverage and offer an EMT-CP certification a year later.

“It did not come easy,” Wirth said. The law allows CP services to be included in a patient’s care plan and billing — with approval from the patient’s primary-care provider.

Authorized coverage includes everything from health assessments and chronic disease monitoring and education, to medication compliance, minor medical procedures, vaccinations and hospital discharge follow-up care.

When it comes to dealing with your own state, there’s no need to reinvent the wheel.

“Show them the Minnesota law,” Wirth said.

He admits that although we’re starting to see some changes, pursuing legislation to get Medicare to go beyond non-transports is not going to happen overnight. Many states also limit EMS providers to ambulance service operations, and require that ambulances go to the ER.

In this case, partnerships are the key. It may be possible to implement community paramedicine programs through medical practice associations, physician groups and hospitals rather than going through the state.

Now that hospitals will soon be penalized for excessive readmissions under the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), it makes sense to start an initiative focused on acute myocardial infarction (heart attacks), heart failure, and pneumonia — which are the readmissions HRRP has identified as those that hospitals need to reduce in order to avoid penalties.

“The money,” Wirth said, “that’s where this is going to benefit.”

Collaborate on a fundamental change

Of course, it helps if your hospital is supportive of a proposed community paramedicine program from the start — along with doctors, health agencies, nursing groups, assisted living facilities and other organizations in the health care field.

These groups should see community paramedicine not as a threat, but rather a way for everyone to work together to meet a common goal of increasing patient access to health care, increasing patient outcomes to health care, and reducing costs.

“It really comes down to collaboration in overcoming these obstacles,” Wirth said.

Meeting with hospital administrators before proposing a community paramedicne plan, and coming up with one together, can go a long way in making sure the plan is successful, he said. “It’s also about showing other health care providers how EMS can add value to its piece of the pie. Taking the lead in the coordination of patient services and care can also lead to public education and acceptance.

“We need to demonstrate we’re not just a bunch of ambulance jockeys,” Wirth said.

And it’s important to present community paramedicne programs as an expansion of existing services and skills.

“Don’t paint a picture that this is a big new thing,” he said. At the end of the day, it really comes down to the changing the “if you’re sick, call 911″ mentality, and getting EMS in at the ground level.

“There are some really cool opportunities for us to get on board a fundamental change,” Wirth said. “And those who get on the train early will benefit the most.”

The post How EMS can clear community paramedicine roadblocks (re-post) first appeared on EMS Billing - Medical Claims Assistance.

This is from John Hultgren with KAPA…

The Kentucky Army National Guard is seeking information as to the availability of employment for its returning military medics in the civilian sector as Advanced EMTs.

They have contracted with Eastern Kentucky University to develop a survey that will gather this information.

Please take a moment and complete the short, three question survey.  Completion time is less than one minute and will provide valuable data for the National Guard.  This survey will be active until July 14, 2014.

Visit the survey at:  https://www.surveymonkey.com/s/J7WWBHL

The post An Urgent Request For Kentucky EMS Squads first appeared on EMS Billing - Medical Claims Assistance.

West Virginia Pushes Toward Interoperability

The post Important Information for West Virginia EMS Squads... first appeared on EMS Billing - Medical Claims Assistance.