2016-698 Emergency Svc - North State Medical Transport - Application for Services Franchise by Ordinance

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applicable to a particular patient. NSMT operating procedures may prescribe additional specific procedures for Dispatch Personnel to address PCS issues, so long as such procedures are approved by NSMT's Compliance Department. 1. Scheduled Repetitive Non-Emergency Transports: NSMT is required to obtain a PCS dated no earlier than sixty days prior to the date of service in order to bill Medicare for repetitive transports. The PCS must be on file, or must be obtained prior to the transport. "Repetitive transports" are those transports that occur three or more times during a ten day period or at least once per week for at least three weeks for treatment of the same condition, such as dialysis and respiratory therapy. This would exclude transports for follow-up visits relating to a single and non-continuing incident. The PCS for a repetitive transport must be signed by a physician. Subject to any approved local standard operating procedures, Dispatch Personnel should either verify that a PCS dated within the last 60 days is already on file at NSMT, or should notify the requesting party that a PCS will be needed before the transport. If the requesting party indicates that they do not have a PCS, Dispatch Personnel should offer to fax over a PCS foriii and should note that the patient is a repetitive patient and that no PCS is on file. Any information regarding the existence of a PCS or the need for one should also be included in the Zoll notes. It will be the responsibility of Medical Transport Personnel to obtain a PCS if required during transport. 2.Non-Emergency Services for a Facility Patient under the Care of a Physician: For these patients, NSMT must attempt to obtain a PCS within 48 hours after the transport whenever possible. If it is not possible to obtain a PCS signed by the physician, a signed PCS can be obtained from a P.A.,N.P., clinical nurse specialist, R.N. or discharge planner who is employed by the hospital/facility where the beneficiary is being treated and from which the beneficiary is transported, or employed by the beneficiary's attending physician, and who has personal knowledge of the beneficiary's condition at the time the transport is ordered or performed. Dispatch Personnel should mention the need for a PCS and, if needed, offer to fax over a PCS form. Any information regarding the existence of a PCS or the need for one should be included in the Zoll notes. D. If you determine that a Medicare transport is NOT "medically necessary" and therefore will not be a covered service, you should follow the NSMT operating procedures, which may include notification of the appropriate supervisor of the transport. The supervisor will assist in handling these types of transport requests. Some recommendations of appropriate processes include: 1. inform the person or facility who scheduled the transport that the payor will probably not cover the service and that the patient or facility will likely be responsible for the entire bill; 2. give the patient or facility the option to downgrade to a lower mode of transport, such as "Wheelchair Service"; 3. include in Zoll Dispatch Notes any approved rates; or 4. request payment at time of transport for all non-covered services to prevent improper billing to third party payors. See NSMT's Policy on Determination of Medical Necessity. E. Under the PPS system applicable to Skilled Nursing Facilities, some Medicare transports are the financial responsibility of the facility and some transports are billable to the Medicare Carrier. Dispatch Personnel shall determine whether the transport may be included in the PPS program. The process for making this determination should be done in accordance with approved operating procedures. Some recommendations of appropriate processes include; 38