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

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1862(a) (1) of the Social Security Act. ABN forms do not apply to emergency transports. The ABN guidelines include the following ground transports: 1. the level of care being provided is higher than the level of care the patient requires. 2. transport from a residence to a hospital for a service that could be performed more economically in the residence. 3. transport of a SNF patient to a hospital or second SNF for a service that could be performed more economically in the first SNF. B. Field providers may be informed by Dispatch Personnel when a patient requires an ABN or may make this determination themselves. C. In the rare circumstances when an ABN is required,NSMT follows the following procedures: 1. If the patient has the capacity to understand or there is an authorized representative (e.g., a family member or other person authorized to make health care decisions on the patient's behalf), field providers must inform the patient or representative that NSMT has reason to believe their ambulance transport is not a covered Medicare benefit because it will likely not be deemed by Medicare to be reasonable and necessary for one of the reasons specified above. These reasons are also set forth on the ABN form used by NSMT, and the Field Provider must check the applicable box corresponding to the reason. The crew member must also complete certain other parts of the ABN by filling in the patient's name, trip/run report number, reason Medicare may not pay and estimated cost of service. 2. The ABN form gives a beneficiary three options with respect to the provision of the service. If the beneficiary chooses "Option 1," the beneficiary chooses to receive the service and to be responsible for payment if Medicare does not pay. If the beneficiary chooses "Option 2", the beneficiary is accepting responsibility for payment without Medicare being billed. If the beneficiary chooses "Option 3," the beneficiary chooses not to receive the service. The crew member should ask the beneficiary to indicate which option he/she chooses by checking the box and then signing the form, acknowledging his/her understanding of the form. a. A beneficiary should not be asked to sign an ABN form under duress, e.g., during a medical emergency. Also, if a beneficiary is comatose, confused, or legally incompetent, the use of an authorized representative is required, if one is available. An authorized representative or interpreter must also be used, if available, if the beneficiary is not literate in the language of the ABN or if the beneficiary is visually impaired. 3. In situations where an ABN is required, if a beneficiary is able to sign but refuses to sign an ABN and still requests the service, the crew should have a second person witness the beneficiary's refusal to sign the ABN and then furnish the service. Ideally, the second witness should be someone other than the other NSMT crew member, but that crew may witness the refusal if there is no one else available to do so. POLICY REVIEW The NSMT Compliance Officer will review and update this Policy and all Compliance policies when necessary in the normal course of its review of the NSMT Compliance Program. 46