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4. If the patient is an ESRD patient, inquire about insurance coverage and how long the patient has been <br /> diagnosed with ESRD and make notation. <br /> C.NSMT shall perform the following tasks regarding each repetitive patient forwarded for review: <br /> 1. Verify the insurance coverage of the patient; <br /> 2. For Medicare patients, ensure that a PCS has been completed by the patient's physician prior to the <br /> transport but no earlier than 60 days prior to the date of transport. The PCS should be updated, at a <br /> minimum, every 60 days, or whenever there is a material change in the condition of the patient which <br /> bears on the medical necessity of ambulance transport.For patients with other types of third party <br /> coverage, a certificate of medical necessity or other verification of medical necessity may also be <br /> necessary. Such documentation should be reevaluated and renewed on a periodic basis,not to exceed <br /> every 60 days or as required by the payor. <br /> 3. Ensure perfolinance of a site survey of the patient to document the patient's condition and the level of nursing <br /> care being received. The initial Site Survey should be completed as quickly as possible, once notified of the <br /> repetitive patient status and every 60 days to assess any changes in the patient's condition. A Site Survey Form <br /> (See: Repetitive Patient Assessment Form) should be completed during each patient visit. <br /> 4. Review PCRs to determine if the patient's condition has changed since the previous transport and PCS. If the <br /> patient's condition has changed, a new site survey is required immediately to verify the patient's continued <br /> need for ambulance transportation. <br /> 5. For End Stage Renal Disease ("ESRD")Medicare patients, determine if the patient is in a skilled bed and <br /> confirm that the correct modifiers have been used in the billing process. If an incorrect modifier has been <br /> used, ensure that the Billing Department makes the appropriate change of modifier. Modifiers generally <br /> associated with dialysis transports include: <br /> a. "G" -hospital-based dialysis facility; <br /> b. ".I" -non hospital-based dialysis facility; <br /> c. "E"residential, domiciliary, custodial facility(other than a skilled nursing facility); <br /> d. "R" - residence; and <br /> e. "N"- Skilled Nursing Facility <br /> 6. Maintain a computerized spreadsheet of all Repetitive Patients that includes first date of service, <br /> origin/destination, modifiers (Medicare patients), primary and secondary insurance, effective date of the <br /> most recent PCS (e.g.,physician's signature date), date of most recent Site Survey, and last date transported, <br /> as applicable. <br /> 7. Ensure that follow-up PCS's and Site Surveys are requested and received every 60 days. <br /> 8.Notify Dispatch Department whenever a repetitive patient's condition no longer- qualifies for ambulance <br /> transportation. <br /> 51 <br />