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

Browse Search

C. In order for a patient to qualify as bed confined the condition causing the bed confinement must be clearly documented on the Patient Care Report. "Bed-confined" means that all three of the following conditions exist: 1. The patient is unable to get out of bed without assistance; 2. The patient is unable to ambulate; and 3. The patient is unable to sit in a chair or wheelchair. "Nonemergency transportation by ambulance is appropriate if either: the beneficiary is bed-confined and it is documented that the beneficiary's condition is such that other methods of transportation are contraindicated; or, if his or her medical condition, regardless of bed confinement, is such that transportation by ambulance is medically required. Bed confinement is not the sole criterion in determining the medical necessity of ambulance transportation, but is instead one factor that is considered in medical necessity determinations. Bed confinement alone does not necessitate the use of an ambulance. In order for the transport to meet the medical necessity criteria, there must be a reason why other modes of transport are contraindicated. Bed-confined is not synonymous with non-ambulatory since a paraplegic or quadriplegic person is non-ambulatory but spends a significant amount of time in a wheelchair. Bed- confined is also not synonymous with bed rest, a recommended state that does not exclude occasional ambulation to the commode or time spent in a chair. III. PHYSICIAN CERTIFICATION STATEMENTS A. 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. 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 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. 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. If unable to obtain the required PCS from either the physician or one of the other parties above within 21 days, a non-repetitive transport can be billed if there is documentation of the attempts to obtain it. Acceptable documentation includes any U.S. Postal document (e.g., signed return receipt or Postal Service Proof of Service Form 3877) that reflects that an attempt was made to obtain the PCS. B. Dispatch Personnel should 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. 48