I got to sit in on a meeting with our billing company the other day and had a nice little discussion about what constitutes an ALS call.
In their non-clinical world only a call where a person performs an ALS skill is an ALS call.
I couldn't disagree more.
I see what they're going for, thinking about justifying our ALS rate for the guy who claimed to be suffering a stroke, but got no treatment.
But WHY did he get no treatment? Because of a good ALS assessment. That, to me, makes it an ALS call. If we get on the scene with a BLS engine and they're able to determine the transport is BLS, great. Trouble is I have no BLS cars in my fleet, so even if I stick an EMT in the back I still have a Medic driving. Plus there's the stickler that the regulatory agency requires an ALS assessment on all patients.
So there we were, arguing whether or not running an EKG is an automatic ALS transport, him taking the side that it can't be because it didn't show anything and me arguing that that's the entire point. ALS isn't the tools we carry or the skills we practice, it is our assessment skills.
I can train a cat how to intubate, but I can't train him when not to.
Our assessment skills are what make the difference between a BLS and an ALS patient. Plenty of ALS patients can be treated with BLS in the short term, sure, let's not get into a BLS vs ALS pissing match, but instead shift our focus from what's in the toolbox to when and WHY to use what's in there.
Discussion finished, and me having lost, I wondered about the inefficiency of an all ALS transport system. Perhaps I can convince the state and County to open their minds to alternate options. We already transport to a specific alternate facility, perhaps more research is in order?
Just hope I can bill it at the ALS rate.
In their non-clinical world only a call where a person performs an ALS skill is an ALS call.
I couldn't disagree more.
I see what they're going for, thinking about justifying our ALS rate for the guy who claimed to be suffering a stroke, but got no treatment.
But WHY did he get no treatment? Because of a good ALS assessment. That, to me, makes it an ALS call. If we get on the scene with a BLS engine and they're able to determine the transport is BLS, great. Trouble is I have no BLS cars in my fleet, so even if I stick an EMT in the back I still have a Medic driving. Plus there's the stickler that the regulatory agency requires an ALS assessment on all patients.
So there we were, arguing whether or not running an EKG is an automatic ALS transport, him taking the side that it can't be because it didn't show anything and me arguing that that's the entire point. ALS isn't the tools we carry or the skills we practice, it is our assessment skills.
I can train a cat how to intubate, but I can't train him when not to.
Our assessment skills are what make the difference between a BLS and an ALS patient. Plenty of ALS patients can be treated with BLS in the short term, sure, let's not get into a BLS vs ALS pissing match, but instead shift our focus from what's in the toolbox to when and WHY to use what's in there.
Discussion finished, and me having lost, I wondered about the inefficiency of an all ALS transport system. Perhaps I can convince the state and County to open their minds to alternate options. We already transport to a specific alternate facility, perhaps more research is in order?
Just hope I can bill it at the ALS rate.
Comments
No, you can't change that by going "all ALS." Medicare (and all the others mostly follow Medicare) only pays for what is necessary. Our system is all ALS, but the above still applies.
So your billing contractor is costing you money.
You DO need a good dispatch system and a good PCR system to make this work, but if you have that data it is a simply algorithm to apply.
I believe the term is "Condition at Dispatch", which means what the caller told the call taker made the call taker enter it as an ALS call. As long as the ALS crew did an ALS assessment, it can be billed as an "ALS 1". At least that's how I remember it. I think that even extends to cardiac arrest calls where the patient is determined to be non viable for resuscitation.
I was also told, although I never verified it, that if you use a third person to drive, you there is an item for that.
And that if you had to use an intermediate device to move the patient from where they were to the stretcher (stair chair, scoop, back board) that was a billable item.
Skip is right, even though you are an "all ALS" system, you can't bill all transports as ALS. Dallas FD was doing that and ended up getting sued by CMS for over billing. They tried the defense of "we staff our ambulance with all paramedics, so all transports are ALS". Not so much according to CMS. They settle for a small proportion of what the initial complaint was, but it was still expensive.
Finally, maybe you should consider adding some BLS ambulances to the mix.
I'm impressed!
The first step would be to get paid for doing stuff and not transporting, like fixing hypoglycemic patient.s Then, we can work on transporting patients who need to be in the hospital and need an ALS assessment, but don't need defib, IV, ETT, etc...