Why are people still transporting Adult medical codes?

[JPINFV]

Sure. You can send a bill to the estate of the deceased. Collecting on that bill, in every area I've worked, has been an exercise in futility.

It was explained to me that insurance won't pay if there's no transport. As insurance was a more reliable means of collecting something out of a cardiac arrest we were told to transport all codes.

If I've been provided with incorrect information regarding insurance billing of cardiac arrests I'd be interested in reading more correct information.

They can still go after the estate. The question is, do they want to go through the effort and the press reports after they sell the debt to a collections agency or start doing things like putting a lien on the assets of the estate?

I'm not arguing that insurance isn't easier, and that at least Medicare requires transport (your money may vary with the other insurance companies). Just that it isn't the only way to bill for calls.

Edited December 5, 2011 by JPINFV

[HERBIE1]

According to the people who did the billing at one place I worked, you can't bill for the call if you don't transport.

They didn't like me much. They couldn't bill for a good number of the codes I ran because I called them.

Otherwise, you need to talk to your medical director.

Excellent point. I completely looked past this. In our system, we cannot bill unless we transport, which means anyone who is treated and released- anything from giving out a bandaid to giving someone an amp of Dextrose- all the way up to a termination of resuscitation in a nursing home- we eat that bill. That is why we are considering implementing a charge for treat/nontransport calls- to capture all that missed revenue. Whether or not the insurance carriers will pay is another story- and I am not aware of those rules. If anyone thinks this is only about patient care and not $$$- they are sadly mistaken.

Then again, our system is also very archaic in many ways, so it is about being conservative as well.

[Kaisu]

On calls where we have first response, we have often come upon resuscitation in process. When the effort is called in the field, we are told to record the call as a stabilization complete with PCR for billing. (nothing is as stable as dead ).

Stabilizations are billable.

PS.. there is no real pressure by the company to NOT call it a stabilization. Most of us report it as cancelled call - no transport and the company appears OK with that.

Edited to add the PS

Edited December 5, 2011 by CrapMagnet

[Bullets]

Because we have too, not much else there

Unfortunatley we transport most dead people because OLMC are unwilling to call a patient over the phone. OLMC doesnt trust their medics

[mobey]

OLMC doesnt trust their medics

(In your area)

As a general rule though.... Can you blame them?

[JakeEMTP]

Excellent point. I completely looked past this. In our system, we cannot bill unless we transport, which means anyone who is treated and released- anything from giving out a bandaid to giving someone an amp of Dextrose- all the way up to a termination of resuscitation in a nursing home- we eat that bill. That is why we are considering implementing a charge for treat/nontransport calls- to capture all that missed revenue. Whether or not the insurance carriers will pay is another story- and I am not aware of those rules. If anyone thinks this is only about patient care and not $$$- they are sadly mistaken.

Then again, our system is also very archaic in many ways, so it is about being conservative as well.

We send a bill to the pt. if we don't transport. If you call 911 and we respond just to "check you out" or treat your hypoglycemia and then you don't want to be transported, you get a bill. We just don't show up at your door, you called us. We provide a service and bill accordingly.

As for transporting codes, that would be a negative. If we can't get ROSC on scene, then we don't transport.

[HERBIE1]

We send a bill to the pt. if we don't transport. If you call 911 and we respond just to "check you out" or treat your hypoglycemia and then you don't want to be transported, you get a bill. We just don't show up at your door, you called us. We provide a service and bill accordingly.

As for transporting codes, that would be a negative. If we can't get ROSC on scene, then we don't transport.

Sounds like a very reasonable- and rational- policy. Wish we had one that was similar.

[Bieber]

It's due to the popular misconception that there is some magical treatment held only at the hospitals which has mysteriously been left out of the hands of the medical providers in the most crucial position to make a significant difference to patient's suffering from out of hospital cardiac arrest, the potency of which is so great that it overrides and undoes the irreparable damage that results from ceasing CPR to transfer patients from scene to the ambulance and the additional damage incurred by poor CPR in the back of a moving vehicle.

What I would consider an ideal system: ROSC or bust, or in special situations where there might be some treatment or diagnostic measure not commonly carried on ambulances due to prohibitive costs or other factors that could possibly make a difference, place that tool (be it iStat, equipment for non-routine resuscitative procedures such as a portable ultrasound for in field pericardiocentesis, etc) on a supervisor's vehicle OR if that isn't possible then at minimum a mechanical compression device in its stead to ensure that either the specialized treatment comes to the patient or that transporting the patient to the specialized treatment does not compromise CPR--which holds precedence over all other treatments, save for defibrillation with which it is on par.

Zmedic, while transporting a patient to the hospital to perform those diagnostic tests may be helpful in uncovering reversible causes of the cardiac arrest (though in my opinion not as good as bringing those tests to the patient), it's meaningless and useless knowledge to know what the cause (reversible or not) of the arrest was if by the time the patient reaches the hospital their heart and brain are shot from the inadequate CPR en route. You can reverse the arrest, but you'll only be bringing back a brain-dead body.

[Just Plain Ruff]

Actually I transport all dead people in arrest(and who that is dead isn't in arrest) because I look like I really tried to save their families loved one. I look the hero and even though I know what the outcome is, I still have a little bit of hero wannabe in my blood.

but seriously, I think the only reason that is valid for transport is medical director/protocol requirements.

If the protocols haven't kept up with the times and the medical director/base station physician are still stuck in the dark ages of transport all codes, then are you sure that your service is really all that progressive?

[Bullets]

Actually I transport all dead people in arrest(and who that is dead isn't in arrest) because I look like I really tried to save their families loved one. I look the hero and even though I know what the outcome is, I still have a little bit of hero wannabe in my blood.

If the protocols haven't kept up with the times and the medical director/base station physician are still stuck in the dark ages of transport all codes, then are you sure that your service is really progressive?

This and this, sort of.

I think there is a misunderstanding in the public that there is more that can be done at a hospital then in the field, and services think that transporting the dead decreases the possibility of a suit because "EMS didn't help my dad/mom/sister/dog, the let him die"

Or for concerns of provider safety...I've had more then a few codes where the living get physical with EMS because they think we are giving up

Also, I'm in NJ, ain't to much progressive EMS 'round these parts, squads still backboard off MOI. one service requires c-spine in all GSW