Medical Necessity criteria still have to be met for the return trip from the ER to the SNF to be covered separately (outside the consolidated bill). Perhaps the ambulance company doesn't feel/or don't have a physician cert that the return trip is medically necessary?
Maura Hinckle, RN Director, Reimbursement Services Phone: 610-925-1042 Fax: 610-925-4353 e-mail: [EMAIL PROTECTED] -----Original Message----- From: Corey [mailto:[EMAIL PROTECTED] Sent: Friday, October 31, 2003 8:43 PM To: [EMAIL PROTECTED] Subject: Re: Attention Carol - Consolidated Billing - Help! having a senior moment I'm wondering if the problem here is that the patient was not deemed to be an emergency and was just sent back? >>Consolidated Billing - Ambulance to ER for an > EMERGENCY visit, resident not admitted. We are responsible for BOTH > the ambulance ride TO and FROM the ER if patient is MED A,<< ----- Original Message ----- From: "Jennifer Russo" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, October 30, 2003 4:04 PM Subject: Attention Carol - Consolidated Billing - Help! having a senior moment > Carol, do you know where I can find the back up documentation to > support this so when the ambulance company gives me a hard time, I can > site something in writing? Thanks > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of > carol maher > Sent: Thursday, October 30, 2003 10:59 AM > To: [EMAIL PROTECTED] > Subject: Re: Consolidated Billing - Help! having a senior moment > > > > No, emergency ambulance transports are an exclusion if the resident meets > the criteria for needing an ambulance. Routine trips to a doctor's office > or clinic in an ambulance are not excluded, but emergency ER visits > are exclusions. > > -----Original Message----- > From: Jennifer Russo <[EMAIL PROTECTED]> > Sent: Oct 30, 2003 7:20 AM > To: "[EMAIL PROTECTED] Org" <[EMAIL PROTECTED]> > Subject: Consolidated Billing - Help! having a senior moment > > I am having "senior moment" Consolidated Billing - Ambulance to ER for > an EMERGENCY visit, resident not admitted. We are responsible for BOTH > the ambulance ride TO and FROM the ER if patient is MED A, am I > correct?? > > > /---------------------------------------------------------- > The Case Mix Discussion Group is a free service of the American > Association of Nurse Assessment Coordinators > "Committed to the Assessment Professional" > Be sure to visit the AANAC website. Accurate answers to your > questions posted to NAC News and FAQs. > For more info visit us at http://www.aanac.org > -----------------------------------------------------------/ > > /---------------------------------------------------------- > The Case Mix Discussion Group is a free service of the American > Association of Nurse Assessment Coordinators > "Committed to the Assessment Professional" > Be sure to visit the AANAC website. Accurate answers to your > questions posted to NAC News and FAQs. > For more info visit us at http://www.aanac.org > -----------------------------------------------------------/ > > > /---------------------------------------------------------- > The Case Mix Discussion Group is a free service of the American > Association of Nurse Assessment Coordinators > "Committed to the Assessment Professional" > Be sure to visit the AANAC website. Accurate answers to your > questions posted to NAC News and FAQs. > For more info visit us at http://www.aanac.org > -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ ****************************************************************** This e-mail and any attachments may contain information which is confidential, proprietary, privileged or otherwise protected by law. The information is solely intended for the named addressee (or a person responsible for delivering it to the addressee). If you are not the intended recipient of this message, you are not authorized to read, print, retain, copy or disseminate this message or any part of it. If you have received this e-mail in error, please notify the sender immediately by return e-mail and delete it from your computer. ****************************************************************** /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
