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Billing for Services.
Here is an interesting article.
I'm sure there will be more on it, but the claim is that the ambulance was billing Medicare/Medicaid at a higher rate by changing the status of the call from BLS to ALS.
Is this an exception or is it more prevalent than is reported?
See story: http://www.clintonherald.com/local/local_story_273111157.html
I'm sure there will be more on it, but the claim is that the ambulance was billing Medicare/Medicaid at a higher rate by changing the status of the call from BLS to ALS.
Is this an exception or is it more prevalent than is reported?
See story: http://www.clintonherald.com/local/local_story_273111157.html
Replies to This Discussion
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Permalink Reply by K Cornett on
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I'm curious to hear other responses as well. I was having dinner with a friend at a different local dept one night and the paramedics were in for dinner, too. They were saying how they had been getting priority one calls to transport patients from one hospital to another that were not priority one... it seemed like a ploy to bill for more money. This became apparent when a doctor told them to move the patient as quickly as possible... so the paramedic called in a life-flight to move the patient... the doctor went off because he didn't authorize that but the paramedic did as he was told. Would seem as though a life-flight would show up as suspicious but not a priority one transport across the city...
Anyone else have similar stories?
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Permalink Reply by Oldman on
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Sadly Art,
this is more common than a lot of people realize. Many services do this, a few get caught, most do not. However, to be fair, it is not just ambulance services that are guilty of this practice and others in order to get more money. Hospitals, Nursing Homes and care facilities, Home medical equipment dealers, etc. have been found "skirting" the rules at various times.
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Permalink Reply by Art "ChiefReason" Goodrich on
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Exactly.
It is not uncommon to hear of a nursing home or a hospital getting nailed for Medicare/Medicaid violations, but if someone at the state level-say, the Department of Public Health-are reviewing the run sheets, then how can you even think that you are going to get away with calling a small laceration with veinous bleeding a life threatening condition and that your effort to file a false report to increase your billing rate will go unnoticed?
Call me crazy, but I don't see how if people are doing their jobs how this can be.
Unless you are in bed with the banks or insurance companies, you are going to get caught.
And especially if you have straight shooters in your organizations.
TCSS.
Art
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Permalink Reply by Loyd Dittfurth on
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there is a hospital that i sued to haul alot of patients to they would keep patients that need to be transfered for 3 days just so they could get paid first WHEN THE PATIENTS WERE TRANSFERED MOST DIED INROUTE
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Permalink Reply by ashfire on
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Our county is charging for ALS and BLS but I don't know if they are after Medicare/Medicaid money or just doing it to get money to keep things running.
The county has become money straped because they say taxes is not keeping things running.
We have a charter government which has grown out of control of its self.
We have a property tax cap and they keep finding more ways to tax the public.
They have just laid off over a 100 employees through out the county and shut off services.
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Permalink Reply by blair4630 on
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I believe this probably goes on, in fact have heard of services that require every BLS tripsheet to include documentation of a "paramedic assessment performed", although don't know why they make them do that, maybe for billing? Not sure.
I will say this though, sometimes it can be a gray area, while still being legitimate. I often upgrade calls dispatched BLS because I keep a high index of suspicion and will go through the motions so to speak on otherwise stable pt.'s.
Example: Diabetic female feeling ill all day, some nausea, feeling run down, no other symptoms....Many medics I know would give this pt. to the EMT to take in BLS, I would not. She's diabetic and female, two of the three (other being age) major factors that often mask the typical pains of AMI (heart attack). From me, she would get a little O2, a glucose check, EKG, 12-lead EKG, saline lock, and full physical assessment. That is the standard of care this pt. will get in the hospital ED, so that's what she should get in the field.
Now, I take this pt. and another medic takes (for example's sake) an identical pt., but turfs it to his/her EMT (because 15-20 minutes of paperwork is sooo hard, I digress). The forms are done, and one is submitted BLS, the other ALS...same exact pt. presentation....and both are billed accurately for the care that was provided.
As far as upgrading a call that was actuallly handled BLS, then maybe that would be more along the lines of what I first mentioned in my post, however I don't want to say that because there may be a legit reason that service does it (it is a very reputable service). I, like you, don't know the answer to this.
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Permalink Reply by Jay Nicholson on
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Along those lines- we used to have something called a 'medic dump'. Medics are usually dispatched to ALL calls. When they got on scene they use to downgrade the call to BLS if appropriate. Of course once they figured out that they were loosing revenue on the transport side, that stopped real quick. If ALS is dispatched, it's an ALS call all the way now with very few exceptions.
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