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Policy on Repetitive Patients <br /> I. INTRODUCTION <br /> A. This Policy is intended to help assure that NSMT bills Medicare and other government programs for <br /> repetitive transports only when those transports meet medical necessity requirements. "Repetitive <br /> transports" are those transports that occur three or more times during a ten day period or at least once per <br /> week for at least three weeks for treatment of the same condition, such as the types of treatment listed <br /> below. This would exclude transports for follow-up visits relating to a single and non-continuing incident. <br /> A repetitive patient Physician Certification Statement (PCS) must be signed by a physician and is valid for <br /> 60 days from the date of signature. The following are some examples of services that may result in <br /> repetitive transports: <br /> 1. dialysis; <br /> 2. hyperbaric services; <br /> 3. radiation treatment; <br /> 4. chemotherapy treatment; <br /> 5. wound care; and <br /> 6. physical therapy services. <br /> II. RULES FOR REPETITIVE PATIENTS <br /> A. In situations where services are provided to repetitive patients, NSMT will ensure that ambulance <br /> transportation is medically necessary, and transport by other means is contraindicated by the patient's <br /> condition. In this regard, a repetitive patient must meet the following criteria: <br /> 1. The patient meets medical necessity criteria for ambulance transport. See NSMT Determination of <br /> Medical Necessity Policy. <br /> 2. A PCS form or other verification of medical necessity signed by the patient's physician is on file; See <br /> NSMT Determination of Medical Necessity Policy. <br /> 3. The treatment received by the patient is consistent with the patient's diagnosed condition. <br /> B. It is recommended that Intake Personnel perform the following tasks when a call is received <br /> requesting transport services for a repetitive patient: <br /> 1. Conduct a regular "medical necessity" assessment and identify likely or potential repetitive patients. <br /> 2. Request a PCS form for Medicare patients as applicable. Verify the medical necessity from the caller <br /> upon scheduling the trip. Stress to the caller the importance of this documentation. <br /> 3. At the time the first transport for a repetitive patient is ordered, inform the caller that a medically trained <br /> employee of NSMT will conduct a site survey to further document the patient's condition. <br /> 50 <br />