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Ambulance service seeks to curb frivolous calls

New policy requires healthcare providers to sign off on need

By Jeremy D. Wells

Carter County Times

The Carter County Emergency Ambulance Service began distributing a letter to healthcare providers last week explaining their new facility pay agreement policy. That policy requires providers who call the ambulance service for emergency care to fill out a form explaining why the transport is medically necessary. The form also includes an agreement that they will cover the costs of the transport if the individual’s insurance plan deems the transport medically unnecessary and refused to cover the cost of the transport.

“We had 23 (transport) calls yesterday,” executive director Rick Loperfido told the ambulance board. “We’re getting slammed, and some of them are legit, and some are not legit.”

While the new policies will not impact other governmental agencies like the jail, they will apply to private entities, “mainly healthcare providers,” Loperfido said.

The main purpose of the form, Loperfido told the board, is for the billing service to have documentation they can provide to insurance when disputing their refusal to pay. But, he said, he hoped it would also discourage calls to 911 for transports that weren’t related to a medical emergency.

“We are moved to take this action due to the increased emergent transport requests received from various healthcare facilities located in the county, which do not meet medical necessity, thus causing a financial issue for non-payment on many transports completed,” the letter sent to providers reads in part. “We are requesting that all healthcare facilities use the correct medical criteria when contacting 911 for an emergency transport to insure when a request is made, our crews will have no issue in documenting the need for the emergency transport to the patient’s insurance carrier for a payment.”

The letter then goes on to ask the providers to take on the financial burden if the insurance carrier declines.

“In turn, if the patient’s insurance carrier determines the emergency transport was not medically necessary, then our billing company will have a signed document from the medical provider authority stating the contrary, in order to dispute the non-payment, or the healthcare facility will accept payment responsibility for the requested transport.”

That final provision, Loperfido said, was one he hoped would encourage care providers to reconsider before calling 911 for non-emergency needs.

In other action Loperfido gave updates on truck repairs and maintenance, and on the new telephone system.

He said the new phone system was “working good” and included “more options” than their old phone system while also saving them money, and that they were allowed to maintain their existing internet service while making the phone system change.

Loperfido and Valerie Nolan also gave updates on a dispute over audit charges, and their resolution of those charge disputes – which closed with the service paying the amount they had initially agreed for the audit and all additional charges removed from the bill.

Loperfido also reported on an upcoming KBEMS field inspection, and a KBEMS approved surgical cricothyrotomy protocol.
He explained the surgical cricothyrotomy would allow staff to make a large incision, if necessary, to facilitate breathing in the event of a blocked airway. He said they currently only have the training and authorization to complete a syringe procedure, which allows them to puncture the trachea with a needle and to leave that in place allow some air to reach the lungs. But, he said, it doesn’t provide the same benefits as a surgical incision. That, he said, would allow even more air to enter the lungs.

“It’s part of the advanced protocol KBEMS (allows),” Loperfido said, adding that the service has a

butcher saving a number of tracheas from butchered hogs for his staff to practice on for their certification.

The board also learned of the installation of eight new video cameras and a DVR system at the Olive Hill station, to help improve security. In addition to covering the building and grounds, and recording digital video, the newly installed cameras can also be accessed remotely and monitored from the main office in Grayson.

In the financial report Nolan noted that the ambulance service currently has a positive net income of more than $448,000 year to date, even with year to date expenses more than $170,000 more than budgeted.

Nolan also reported that payroll for February was $646.23 under budget, even with unscheduled overtime for the month at 4.12% – an increase of 0.96% over the previous month of January.

Contact the writer at editor@cartercountytimes.com



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