Jump to content


Photo

Help In Setting Up New Ground Cct Program


  • Please log in to reply
7 replies to this topic

#1 Dave Sharpe

Dave Sharpe

    Newbie

  • Members
  • Pip
  • 2 posts

Posted 09 February 2009 - 07:47 AM

I am a former flight nurse (with some management experience in that role) and former ground CCT nurse now living and working in a small rural community hospital in Washington State. We currently use the local HEMS program frequently for transfers - both ermegent or non-emergent, but frequently have weather issues forcing us to use ground medics. Our hospital currently has no plan in place to utilize nursing staff for such transports, relying on the hospital-based medics to handle everything. On occasion, we have sent a hospital RT along if the pt is vented (sounds like the 80's all over again, eh?) I've been proposing setting up a ground CCT program but need help in getting started. Specifically, I'd like input in a coouple of areas:

1. Billing - hos are ground CCT programs reimbursed in comparison to ALS transfers? Are there special billing codes you can share with me? (I've had no luck getting my hospital billing department to track this down - no one here has even heard of CCT)
2. Standing orders - I'd like to get some copies of standing transport orders used by other programs to adapt for our needs.
3. Documentation - how do you chart care provided enroute? I'd be einterested in seeing samples of charting forms used by other programs.

If you can help, please email me direct at dave@infoservice.com. I'd really appreciate any and all input.

Dave Sharpe
  • 0

#2 nursemedic

nursemedic

    Advanced Member

  • Members
  • PipPipPip
  • 258 posts

Posted 10 February 2009 - 12:03 AM

Billing by the hospital for a hospital owned and operated service is your biggest challenge and you cannot learn it from flightweb. It takes indepth research and understanding of the Medicare Fee Schedule - you'll be billing Medicare part A. It is much better if your organization will out source this billing because hospital billing departments don't understand the unique requirements of ambulance billing and the billings are low dollar (contrasted with hospital bills) so there is no incentive to work your claims over the big dollar ones. I say if your hospital billing department is not showing interest stay far, far away.
  • 0
Greg

#3 Macgyver

Macgyver

    Advanced Member

  • Members
  • PipPipPip
  • 868 posts

Posted 10 February 2009 - 12:24 AM

Billing by the hospital for a hospital owned and operated service is your biggest challenge and you cannot learn it from flightweb. It takes indepth research and understanding of the Medicare Fee Schedule - you'll be billing Medicare part A. It is much better if your organization will out source this billing because hospital billing departments don't understand the unique requirements of ambulance billing and the billings are low dollar (contrasted with hospital bills) so there is no incentive to work your claims over the big dollar ones. I say if your hospital billing department is not showing interest stay far, far away.


You'll also get better financial returns if legally it is a seperate company - even if 100% owned by the hospital. Medicare pays the hospital last - and as was said, transport will be a very small portion of a hospital bill. A bill from an ambulance would get paid before the hospital bill, or a combined bill from the hospital.

If I hava a grasp on the complexities of this situation.
  • 0
Ken BHSc, RN, REMT-P

#4 medicerik

medicerik

    Advanced Member

  • Members
  • PipPipPip
  • 59 posts

Posted 19 February 2009 - 03:06 PM

I am a former flight nurse (with some management experience in that role) and former ground CCT nurse now living and working in a small rural community hospital in Washington State. We currently use the local HEMS program frequently for transfers - both ermegent or non-emergent, but frequently have weather issues forcing us to use ground medics. Our hospital currently has no plan in place to utilize nursing staff for such transports, relying on the hospital-based medics to handle everything. On occasion, we have sent a hospital RT along if the pt is vented (sounds like the 80's all over again, eh?) I've been proposing setting up a ground CCT program but need help in getting started. Specifically, I'd like input in a coouple of areas:

1. Billing - hos are ground CCT programs reimbursed in comparison to ALS transfers? Are there special billing codes you can share with me? (I've had no luck getting my hospital billing department to track this down - no one here has even heard of CCT)


Dave Sharpe


Billing is something very much best left to ambulance billing experts. If your hospital won't be handling the billing, there are a number of outside companies who are experts in ambulance billing. They usually take between 6 and 10 percent of what they recoup. As they do nothing but ambulance billing, they work off the philosphy that if you don't get paid, they don't get paid. Exact billing requirements vary state to state and within the state itself. Medicare pays a flat fee based off BLS, ALS 1, ALS 2, and SCT transports. Milage re-imbursement is calculated from a formula based off the zip code the transport originitated in and number of miles for the transport. Total medicare reimbursement for CCT will be about three times ALS reimbursement. Again, save yourself a lot of hassle and find one of the EMS specific medical billing companies. They have this down to a science and will save you a considerable amount of time.

Erik
  • 0
Erik Glassman, BS, CCEMT-P, FP-C, EMT-T

#5 Dave Sharpe

Dave Sharpe

    Newbie

  • Members
  • Pip
  • 2 posts

Posted 21 February 2009 - 04:16 PM

Billing is something very much best left to ambulance billing experts. If your hospital won't be handling the billing, there are a number of outside companies who are experts in ambulance billing. They usually take between 6 and 10 percent of what they recoup. As they do nothing but ambulance billing, they work off the philosphy that if you don't get paid, they don't get paid. Exact billing requirements vary state to state and within the state itself. Medicare pays a flat fee based off BLS, ALS 1, ALS 2, and SCT transports. Milage re-imbursement is calculated from a formula based off the zip code the transport originitated in and number of miles for the transport. Total medicare reimbursement for CCT will be about three times ALS reimbursement. Again, save yourself a lot of hassle and find one of the EMS specific medical billing companies. They have this down to a science and will save you a considerable amount of time.

Erik

Thanks Erik and others for your responses,
I absolutely agree from a personal standpoint that I want nothing - nothing - to do with ambulance billing operations. As if I don't have enough on my hands trying to get things rolling on a CCT program. However, the ambulance service in our area is operated by the hospital, so all billing is done by the same department. It's a somewhat isolated community in that we are locaated on an island in Puget sound, with somewhat limited access. Being a small community hospital, we don't offer cardiology, neuro, pediatrics, or other specialty services, so we transport a LOT of patients off island. Your comment that reimbursement for CCT is roughly 3x ALS is interesting to me. If I can get our billling department to confirm that for themselves I think the doors would open. As it is now, there's a lot of inertia to overcome, and an unwillingness on the part of administration to add the expense of a CCT program. My "understanding" from conversations with past employers is that CCT is reimbursed faster and at a higher rate than ALS transports.

Dave
  • 0

#6 medicerik

medicerik

    Advanced Member

  • Members
  • PipPipPip
  • 59 posts

Posted 22 February 2009 - 01:36 AM

Thanks Erik and others for your responses,
I absolutely agree from a personal standpoint that I want nothing - nothing - to do with ambulance billing operations. As if I don't have enough on my hands trying to get things rolling on a CCT program. However, the ambulance service in our area is operated by the hospital, so all billing is done by the same department. It's a somewhat isolated community in that we are locaated on an island in Puget sound, with somewhat limited access. Being a small community hospital, we don't offer cardiology, neuro, pediatrics, or other specialty services, so we transport a LOT of patients off island. Your comment that reimbursement for CCT is roughly 3x ALS is interesting to me. If I can get our billling department to confirm that for themselves I think the doors would open. As it is now, there's a lot of inertia to overcome, and an unwillingness on the part of administration to add the expense of a CCT program. My "understanding" from conversations with past employers is that CCT is reimbursed faster and at a higher rate than ALS transports.

Dave


You want to look up RVU's for each type of transport. For routine cardiac monitor only ALS type of transports, all medicare does anymore is pay a little extra to cover the expense of a higher trained provider in the back of the unit. Medicare billing for the most part comes from how the call is dispatched, not what the call turns out to be. So, if you dispatch a call as ALS, and the medic ends up using 500 bucks in drugs and supplies, from the medicare standpoint, the transport cost you more than you will recoup. The current RVU for ALS 1 is 1.20. For CCT, it's 3.25. Medicare recognizes for CCT, you at the bare minimum have two paramedics in back and are considerably more likely to use expendable supplies then on the routine ALS transport going from the freestanding ED to a tele floor for a 24 hour admit. The current codes for ground ambo billing are:

A0425 -
Ground mileage, per statute mile
A0426 -
Ambulance service, advanced life support, non-emergency transport, level 1 (ALS1)
A0427 -
Ambulance service, advanced life support, emergency transport, level 1 (ALS1- Emergency)
A0428 -
Ambulance service, basic life support, non-emergency transport (BLS)
A0429 -
Ambulance service, basic life support, emergency transport (BLS - Emergency)
A0433 -
Advanced Life Support, Level 2 (ALS2)
A0434 -
Specialty Care Transport (SCT)

Now, things become even more challenging when there is a secondary insurance involved. Certain codes that medicare will no longer reimburse are still reimbursed by secondary insurance companies. This crap drove me nuts when I set up a new ground system. I finally was able to pass it off and focus purely on clinical.

Erik
  • 0
Erik Glassman, BS, CCEMT-P, FP-C, EMT-T

#7 Speed

Speed

    Advanced Member

  • Members
  • PipPipPip
  • 1100 posts

Posted 24 February 2009 - 04:54 PM

Medicare recognizes for CCT, you at the bare minimum have two paramedics in back


I'm getting SCT in Oklahoma with one CCT medic when all necessity is met?
  • 0
Mike Williams CCEMT-P/FP-C

#8 medicerik

medicerik

    Advanced Member

  • Members
  • PipPipPip
  • 59 posts

Posted 25 February 2009 - 01:15 AM

I'm getting SCT in Oklahoma with one CCT medic when all necessity is met?


Let me rephrase, as what I said could be misconstrued. The only CMS staffing requirement to SCT is for there to be a paramedic with additional training and credentials to operate above the normal scope of practice for an ALS provider (EMT-I or EMT-P) within the service. Obviously, the interventions within the transport must be outside the scope of practice for a regular ALS provider as well to bill as SCT. Any other staffing combination, as long as one provider is at least a paramedic with additional training and credentials is based off state law or if not defined within state EMS code, service policy. Some states allow for only one provider in back, some require two. Some states mandate at least one of a specifically trained type of provider be on the unit. This next point is purely conjecture, but I would guess that states that are primarily rural are more willing to allow for one provider in back and not mandate two.

For example intervention wise, in Virginia an EMT-I can transport a patient to the cath lab on Nitro, Heparin, and Integrilin without additional assistance. This gets billed as an ALS 2 transport (ALS 2 for three or more medications administered) as the transport is within the scope of practice of a regular ALS provider. Come across the border into Maryland and a Nitro, Heparin, Integrilin transport is an SCT call because Nitro infusions are only within the scope of practice of an SCT credentialed Medic or higher.

Erik
  • 0
Erik Glassman, BS, CCEMT-P, FP-C, EMT-T