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

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VI. ADVANCE BENEFICIARY NOTICE OF NONCOVERAGE An Advance Beneficiary Notice of Non-coverage (ABN)notifies patients that NSMT believes the service provided may not be fully covered by Medicare because it is not "reasonable and necessary" under Section 1862(a)(1) of the Social Security Act. For more information related to ABNs, see NSMT-Policy on Patient Signatures. VII. PHYSICIAN CERTIFICATION STATEMENT NSMT must attempt to obtain Physicians' Certification Statements (PCS)before it can bill Medicare for scheduled repetitive non-emergency transports and for other scheduled and unscheduled non-emergency ambulance transports of patients under the direct care of a physician. The specific requirements for a PCS depend on whether the transport is a repetitive transport or a non-repetitive transport. Medical Transport Personnel must understand these requirements so that, when appropriate, they can explain them to requesting facilities and assist in obtaining PCS forms required for specific patients. In very(limited) situations a PCS faun may not be obtained at the time of transport. If this situation arises do not create a conflict with facility staff On the (rare) occasion this situation may arise, the dispatch staff must be notified verbally of the situation so that appropriate steps can be taken with the referring customer. A. Dispatch Personnel may instruct Field Providers regarding the need to obtain a PCS at the time of transport, in which case the Field Provider should briefly review the form to make sure it has all the required information and is signed by an appropriate person, as indicated above. B. NSMT Personnel can assist with completion of the demographic portion of the PCS form but cannot enter any of the information in the medical necessity portion of the document. No modifications to the PCS form can be made after it has been signed and dated by an authorized signor. 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 once per week for at least 3 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; These type transport PCS's will typically be handled by dispatch personnel. 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 certification 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. VIII. TRAINING OF MEDICAL TRANSPORT PERSONNEL A. Required compliance training for Medical Transport Personnel will be provided by NSMT's Compliance Department and/or designated employees. Training should take place upon initial employment and annually thereafter. B. Ongoing training for Field Providers, according to NSMT policy, shall include specialized training regarding PCR documentation. NSMT management will work jointly with the Compliance Department to develop and present the specialized training. 43