Ambulance law

[adamsmom2]

I work at a ALF had a resident fall. Was able to get up stated she was fine. A few hours later stated her neck and back hurt. Called PCP he said send her out wanted CT scans. Called family no answer our driver was out doing appointments would not be back till later. PCP said he did not want to wait wanted her out 911.

EMT stated if she can walk to stretcher Medicare will not pay the $800 charge and they are making people sign a form stating they will pay them if Medicare does not pay. Has anyone else heard about this.

[Altra, BSN, RN]

Sounds like a misinterpretation of the Medicare requirement to demonstrate "medical necessity" to utilize ambulance services for nonemergency transports. Sending someone to be evaluated in the ER is not a nonemergency transport.

[Anne36, LPN]

Hmm, that doesnt even make sense. So if you are in a wheelchair you are good to go? We do have a few residents that can still ambulate who could need emergency care. What did you do with that resident? Did anyone sign the paper?

[netglow, ASN, RN]

Many fractures and hemhorragic bleeds will be ambulatory until they aren't ambulatory - I'd have just ignored him and given report and papers and been done with him. Remember EMT training is well short and sweet. Not much breadth of knowledge there.

[classicdame, MSN, EdD]

send her out in a wheelchair

[T-Bird78]

Hadn't heard that one. It may be to keep people from calling 911 to get a ride to their doctor's appointment, but it wouldn't apply in this case. My dad was in a bad car wreck several years ago, the car flipped and he was bleeding from the nose and mouth and ruptures his spleen. My mom got the call and raced to the hospital where the ambulance driver was waiting for her (hanging out by the check-in window to hear who asked for my dad by name) and stopped her from going back with him until she paid the ambulance fee. She argued with him and said she didn't have any money, especially the hundreds they were asking for, and shoved him aside to get to my dad's side. They were billed for the services, but that was so out of line of the ambulance driver. They can be gravely mistaken in some cases and this was one of those times.

[MunoRN, RN]

The criteria for emergency transport is not defined simply by the ability to walk to the stretcher, on that point they were incorrect, but on the general idea they were correct.

In situations where ambulance companies believe the transport may not qualify as emergency transport, they are required to provide the patient with an "Advance Beneficiary Notice of Nonverage". This informs the patient that the service may not be covered by Medicare or their third party medicare coverage provider, in which case the patient will be responsible for the costs.

They were correct in questioning the necessity of this transport; The patient's condition does not warrant emergency transport, and a CT is not indicated in a patient who has no other symptoms after a fall other than muscle soreness, there are very specific criteria for a post-fall head CT that both medicare and private insurers use. A more appropriate option would have been a medical transport service which is usually paid for out of pocket or with a supplemental plan that cover those services. Although sending the patient to ER for evaluation is not necessarily appropriate either as the patient is already under the care of a Physician and doesn't meet criteria for a higher level of care.