| Paramedic's Corner: Advanced Beneficiary Notice of Noncoverage |
By: Gary Carmack, Ambulance Director
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Posted: Wednesday, February 25, 2009 12:20 pm
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Gary Carmack
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The year started off busy for the Pulaski County Ambulance District (PCAD) with 390 patient calls in January of 2009. Things are going well; the only downside so far is the decline in sales tax, some problems with one of our 2008 Chevy ambulances, and we had to have some engine injectors replaced in our 2006 Ford ambulance. The sales tax is down $12,101.68 from January 2008. Of course this is common all across our nation.
With the new government there are and will be new changes in many areas that will affect the ambulance industry. One big change already coming down with the new administration is stricter HIPAA enforcement. I will be attending a class on these new HIPAA changes and I will explain the new HIPAA requirements in a future article. I will cover many of these changes throughout 2009 as more information becomes available. Another subject I will be covering in the near future is ambulance transport to VA hospitals. VA doesn’t allow us to transport emergency patients there and people get very mad at us. VA requires the patient to go to an emergency room first (VA does not have an emergency room). However, for this article I want to tell the readers about a change that came into effect before the change in administration. This is a new Medicare law that goes into effect March 1.
The new Medicare requirement is called “Advanced Beneficiary Notice of Noncoverage” or ABN. This is a notice given to beneficiaries (Medicare refers to patients as “beneficiaries”), that Medicare is not likely to provide coverage in a specific case. In Medicare language this means they might not pay for the service. The reason I want to explain this very carefully is that I am afraid that some patients might think that we are refusing to transport them or won’t transport them with paying upfront. That will never be the case; however the wording of this required Medicare form might confuse the patient. This form is Medicare CMS-R-131 and it is required by federal law that we use the form exactly as provided by Medicare.
The intent and purpose of the ABN requirement is actually a good thing. It is to tell the patient “in advance” that Medicare may not pay the bill. Then it allows the patient to decide if they want the service. The ABN will not affect very many of PCAD’s patients as the form is not for emergencies, 911 calls, or if the patient is in duress.
The following are examples of the mandatory requirements for ambulances to use the ABN form:
1) If the patient is in a skilled nursing facility (SNF), or in residence and the ambulance is called to transport the patient to the hospital for a simple catheter removal or suture removal, which are procedures that Medicare believes could easily be done at the SNF or residence. Medicare might not pay for the ambulance transport, so the patient must be warned in advance that Medicare is likely to not pay.
2) If the level of care is downgraded from advanced life support (ALS) to basic life support (BLS). This won’t affect the Pulaski County Ambulance District because we have a paramedic or RN on all calls. PCAD is a full ALS (Paramedic) service.
3) If downgraded from an air-ambulance to ground ambulance. This won’t affect the Pulaski County Ambulance District much because it is rare to call helicopter for SNF calls. If we call for air-ambulance to a residence, we will be transporting the patient to a landing zone (LZ) and it will be bad enough that we will fly them, so this requirement should be virtually non-existent for Pulaski County Ambulance District patients.
At this time I am cutting the article short so I can include the actual ABN Medicare form and see if my editor(s) have enough space to include it. This new requirement is mandated March 1. If any patient or family member has any questions or concerns, they may call me at (573) 774-5413, or stop by the ambulance base and I will explain the form to you in person.
Also, residents can sop by anytime for blood pressure, vital signs, oxygen saturation, or glucose checks at no cost to the citizen.
Click here for a copy of the Medicare form
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