What Medicare says as a general rule: Medicare covers ambulance services, including fixed wing and rotary wing ambulance services, only if they are furnished to a beneficiary (patient) whose medical condition is such that other means of transportation are contraindicated. The beneficiary's condition must require both the ambulance transportation itself and the level of service provided in order for the billed service to be considered medically necessary.
EMS providers have been challenged over the last 15 years dealing with constant changes in electronic patient care charting. Both national and state organizations have increased and changed the demands for key data elements required in the chart. Some of these data elements take you down rabbit holes requesting more and more data elements.
EMS as an industry is just as challenged as any other health care service. They are understaffed, underpaid, and overworked. The increased demand for data elements hasn’t helped. We are breeding a generation of patient care providers who chart by means of satisfying validation rules rather than providing high quality narratives that paint the picture of what’s really going on with their patient.
Documentation training is really left up to the organization the provider works for. EMS curriculums dedicate less than 3% of their course allotment to documentation education. This along with Medicare regulations requiring your patient meet the need for medical necessity for the ambulance has placed an additional burden on every EMS organization.
Your documentation needs to paint a picture for the reader whoever it may be, EMS QA/QI, nurse, physician, or Medicare auditor. The documentation should clearly identify the need for the ambulance. The individual data elements may without a quality narrative require the reader to do a summation of the data points to paint the picture which may or may not be accurate. The reader will take the pathway of least resistance and go right to the narrative. This is why EMS providers need to focus on their narratives. Don’t just satisfy the validation rules and submit your patient care report (PCR). Review and read your PCR prior to submission. After your review of the PCR ask yourself, did I adequately paint the picture as to why the ambulance was needed.
Please remember the bar set by Medicare is the patient’s medical condition is such that other means of transportation are contraindicated. Please remember everyone has their own definition what an emergency is. Try not to let your exhaustion and opinion influence your charting. Focus on what you were trained to document: the patient’s chief complaint, pertinent history leading up to the event, past medical history, your assessment, treatment, and outcome in your chart. If you do that most of your patients can meet the Medicare regulations.
If you’re looking for training for your staff or you need help understanding these regulations, please reach out to us at firstname.lastname@example.org.