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FFmedic13
12-13-2008, 09:27 AM
I'm not big into the billing end of the profession, so maybe someone who knows more can help.
There is an ALS service that has 3 basic emergency billing conditions... BLS, ALS, and ALS 2. They also have an agreement with the neighboring BLS services that if the paramedic does an ALS assessment and releases the patient to BLS, they bill the BLS service $75. This I can understand.

The issue is that the ALS service has recently taken it to another level. If the service responds to a call in their own coverage area and the medic releases the patient to his own EMT (crew is just a medic and EMT anyway), they bill as ALS, not BLS. There are two obvious problems with this. For one, the medic is always there regardless of the priority of the call, and therefore will always be doing an assessment. Two, since the service is billing the same as if a full ALS workup was done, they're essentially billing for services not rendered. Maybe this is OK, and might be common practice elsewhere, but I have a serious objection to billing an extra $300 or so just so the medic can take 2min to determine that a call is BLS. Also, no other ALS in the region bills like that.
Again, I'm not familiar with the billing process... I simply just have an eerie feeling that something isn't right with that practice.

pediflitechance
12-16-2008, 12:31 PM
I'm not big into the billing end of the profession, so maybe someone who knows more can help.
There is an ALS service that has 3 basic emergency billing conditions... BLS, ALS, and ALS 2. They also have an agreement with the neighboring BLS services that if the paramedic does an ALS assessment and releases the patient to BLS, they bill the BLS service $75. This I can understand.

The issue is that the ALS service has recently taken it to another level. If the service responds to a call in their own coverage area and the medic releases the patient to his own EMT (crew is just a medic and EMT anyway), they bill as ALS, not BLS. There are two obvious problems with this. For one, the medic is always there regardless of the priority of the call, and therefore will always be doing an assessment. Two, since the service is billing the same as if a full ALS workup was done, they're essentially billing for services not rendered. Maybe this is OK, and might be common practice elsewhere, but I have a serious objection to billing an extra $300 or so just so the medic can take 2min to determine that a call is BLS. Also, no other ALS in the region bills like that.
Again, I'm not familiar with the billing process... I simply just have an eerie feeling that something isn't right with that practice.

They can actually bill this as an ALS 1 NonEmergency if a Paramedic performed an ALS assessment and then downgraded care. It may be questionable given the population area you serve, but I do believe it's perfectly legal if the Paramedic documents the performance of an ALS-level assessment and response. Basically, if a Paramedic shows up in a 911 environment it's billable as an ALS-1 Nonemergency or even Emergency.

It's only billable as a BLS call if a Paramedic responds on a BLS interfacility transfer or discharge. At that point, the service has to bill for BLS because no ALS care was necessary.

EMT178
12-27-2008, 09:19 PM
The service I work for also bills along the same lines, it's the medicare billing determinations I think... Anyway the way I understood it was that, if the call was such that a paramedic would be required, and an als assessment was performed, als interventions used, then it would be billed as ALS. I agree with you in that if the paramedic is not riding then clearly there is not a need for ALS and then there should not be an ALS charge. Sounds to me like a company just trying to get every little cent. Legally it may be ok, but that doesn't make it right for the patients. Where I am at, the paramedic rides on all emergency calls, they are the higher trained, and should be with the patient not driving the truck.

kyparamedic
12-28-2008, 09:37 PM
This is permissible in most circumstances. If the dispatched complaint warranted an ALS emergency response according to local SOP's/protocols, and the paramedic only performs an assessment, they may bill at the ALS1 rate. If the information provided by dispatch was insufficient or they do not use protocols, then ALS1 can only be billed if the condition of the patient at the scene warranted an ALS assessment. In neither case does the paramedic have to be in the back with the patient to bill at this level. However, he must document that an assessment was done and ALS care was not necessary.

CH47Doc
01-02-2009, 12:35 AM
I'm not big into the billing end of the profession, so maybe someone who knows more can help.
There is an ALS service that has 3 basic emergency billing conditions... BLS, ALS, and ALS 2. They also have an agreement with the neighboring BLS services that if the paramedic does an ALS assessment and releases the patient to BLS, they bill the BLS service $75. This I can understand.

The issue is that the ALS service has recently taken it to another level. If the service responds to a call in their own coverage area and the medic releases the patient to his own EMT (crew is just a medic and EMT anyway), they bill as ALS, not BLS. There are two obvious problems with this. For one, the medic is always there regardless of the priority of the call, and therefore will always be doing an assessment. Two, since the service is billing the same as if a full ALS workup was done, they're essentially billing for services not rendered. Maybe this is OK, and might be common practice elsewhere, but I have a serious objection to billing an extra $300 or so just so the medic can take 2min to determine that a call is BLS. Also, no other ALS in the region bills like that.
Again, I'm not familiar with the billing process... I simply just have an eerie feeling that something isn't right with that practice.


At my service if i hand off a patient to my basic partner, its a BLS billing, i dont write any report, statement or whatever about the patient. a medic does every assessment so to bill ALS1 for that is shady IMO.

kyparamedic
01-08-2009, 01:00 PM
At my service if i hand off a patient to my basic partner, its a BLS billing, i dont write any report, statement or whatever about the patient.

From a liability standpoint, you should probably document some type of assessment since you handed your patient off to an EMT. However, since you're still readily accessible to the patient, it probably wouldn't be an issue. This is more of a concern with a tiered system where it's conceivable that the patient could deteriorate en route to the hospital after the medic has gone available.


a medic does every assessment so to bill ALS1 for that is shady IMO.
That's your choice, but it's permissible under CMS rules, and you're missing out on money that you should be receiving for doing an ALS assessment. Now there are stipulations, such as the nature of the call and how it's dispatched, but in general, emergency calls where an ALS unit is dispatched can be billed as ALS1 regardless if the medic rides in with the patient. There must be some type of documentation, however.

pediflitechance
01-10-2009, 02:29 AM
Generally, you're only allowed to bill for ALS if the call warrants the use of an ALS skill that requires a Paramedic. An ALS-1/Emergency bill is always used in a 911 environment for the company I work for, and if two or more drugs or advanced skills are used they bill for ALS-2. However, AFAIK, if a paramedic responds to a known BLS call, where BLS resources are used (like a MD, Dialysis, or Interfacility transport) with a BLS statement of need, then they can only bill BLS-Nonemergency or BLS-Emergency (usually used in emergency response billing if something goes south en route or if two EMTs respond to an emergency scene)

Any use of a specialty care resource (isolette, invasive monitoring line such as artline, chest tube, ventillator or use of an RN or RT) can be billed as a "Special" bill type, which is usually twice the amount of ALS-2.

We usually bill ALS-1 or ALS-Emergency on our ground transports at Pedi-Flite, unless the team has to do skills or use an isolette, at which point it automatically becomes Special.


From a liability standpoint, you should probably document some type of assessment since you handed your patient off to an EMT. However, since you're still readily accessible to the patient, it probably wouldn't be an issue. This is more of a concern with a tiered system where it's conceivable that the patient could deteriorate en route to the hospital after the medic has gone available.


That's your choice, but it's permissible under CMS rules, and you're missing out on money that you should be receiving for doing an ALS assessment. Now there are stipulations, such as the nature of the call and how it's dispatched, but in general, emergency calls where an ALS unit is dispatched can be billed as ALS1 regardless if the medic rides in with the patient. There must be some type of documentation, however.

kyparamedic
01-10-2009, 02:27 PM
Generally, you're only allowed to bill for ALS if the call warrants the use of an ALS skill that requires a Paramedic. An ALS-1/Emergency bill is always used in a 911 environment for the company I work for,
Yes, for the most part. Whether or not you can bill ALS or not if the call goes in BLS depends mainly on how your dispatch operates. Whether they use EMD, if it's dispatched out as an emergency, etc. I don't have the exact regs in front of me or I'd quote it. At my service, all our units are ALS but we won't bill ALS automatically unless it's dispatched as a certain condition, such as choking, unconscious, syncope, chest pain, difficulty breathing, etc., as these would warrant an ALS response/assessment. If we get there and it's not what what we were dispatched to or do an assessment and take the call in BLS, we still bill ALS1 since it was dispatched as such.


and if two or more drugs or advanced skills are used they bill for ALS-2.
It's actually 3 or more via IV/IO, or an advanced procedure such as defibrillation, intubation, etc.


However, AFAIK, if a paramedic responds to a known BLS call, where BLS resources are used (like a MD, Dialysis, or Interfacility transport) with a BLS statement of need, then they can only bill BLS-Nonemergency or BLS-Emergency (usually used in emergency response billing if something goes south en route or if two EMTs respond to an emergency scene)
Yes, interfacility transports can only be billed BLS non-emergency unless they require a paramedic due to the monitoring required or drugs/IV's. BLS-emergency would be something like a broken arm, simple laceration, or any other number of things that get an immediate response but don't warrant ALS based on dispatch. However, if an ALS unit responds and administers morphine for that broken arm, then it could be billed ALS1. Just putting the patient on the monitor though with no real indication or just to bill ALS is questionable and the claim will probably get denied.





Any use of a specialty care resource (isolette, invasive monitoring line such as artline, chest tube, ventillator or use of an RN or RT) can be billed as a "Special" bill type, which is usually twice the amount of ALS-2.

We usually bill ALS-1 or ALS-Emergency on our ground transports at Pedi-Flite, unless the team has to do skills or use an isolette, at which point it automatically becomes Special.
Anything that requires special training above and beyond that of standard paramedic training or requires specialty personnel (RN or RT) can be billed at the SCT rate, which is higher than ALS2. We use transport ventilators for interfacility transfers which is not part of standard paramedic practice in my state. Therefore we can bill SCT for this as we all must have specialty training and approval by the EMS board to do this.