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Re: place of service
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Steve Verno
Re: place of service
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Jul 11 05 6:03 AM
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You may be set up like an Emergency Department but you are not an emergency department. Based on your own words, you are an office.
An emergency department is clearly defined:
An emergency department is defined as an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.
This is in your CPT manual.
In addition, Federal Law (42 CFR 489.24) makes the following requirement for an emergency department:
(1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department;
(2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or
(3) During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.
So, is your clinic licensed under your State Law, as an emergency department? If not, then you are not an emergency department regardless of the fact that you have ED physicians staffed and you have some emergency equipment.
I would be very careful on calling yourself an emergency department. I am sure you are aware of the EMTALA law. What will you do if you call yourself an emergency department and you are treating a severly injured patient who is unstable upon arrival. The patient remains unstable in your clinic. How do you plan on getting the patient to the hospital while the patient remains unstable? You would be in violation of EMTALA if you attempted to transfer the patient.
I have been a paramedic for the last 33 years. If I put a gurrney, an oxygen tank, a bag containing splints and dressings in the back of my station wagon and put emergency symbols on the doors and windows of my station wagon, can I call it an ambulance?
To become a specialty hospital, you would have to be licensed by the State as such, and you would be required to undergo credentialization by JCAHO.
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Association News
Medical Billing & Coding Education from the MAB
Continuing Education
Management Advice and Training
Questions Asked More Than Once
Help Wanted - Billing and Coding
Non Billing Talk
The Venting Area (Clean posts please)
Medical Coding and Billing News
Fraud and Abuse
Health Insurance - Provider Contracting
ERISA
Tricare
Workers' Compensation
General Medical Billing Questions
Appeals
Accounts Receivables (A/R)
Refunds
Auto Accident Issues
Medisoft Technical Support
Medical Software Technical Support Questions Other than Medisoft. No Investigation Questions!
General Medical Coding Forum
CPT Coding Questions
HCPCS Coding Questions
ICD-9-CM Coding Questions
Evaluation & Management Coding Questions
Acupuncture Billing and Coding
Ambulance Coding and Billing
Cardiology Coding and Billing
Chiropractic Coding and Billing
Dental Billing and Coding
DME Coding and Billing
Emergency Department Coding and Billing
Family Practice Coding and Billing
Hospital Inpatient and Outpatient Coding
Hospital Billing, Appeals and Collections
Internal Medicine Coding and Billing
Laboratory Coding and Billing
Ophthalmology Coding and Billing
OB-GYN Coding and Billing
Pain Management Coding and Billing
Pediatric Coding and Billing
Podiatry Coding and Billing
Physical Therapy Coding and Billing
Psychiatry Coding and Billing
Radiology Coding and Billing
Surgery Coding and Billing
Neurology Coding and Billing
Urgent Care Coding and Billing
Provider Compliance
Billing Center Compliance
HIPAA
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