Sunday, December 26, 2010

Speciality Care Transports billing

Specialty Care Transports

SCT is a highly skilled level of care of a critically injured or ill patient during transfer from one hospital to another (Effective 1-1-07, coverage is provided for inter-facility transports*). Typically, this occurs when the patient, who is already receiving a high level of care in the transferring acute care hospital, requires a level of care that the transferring hospital is not able to provide. This includes the situation where a beneficiary is taken by ground ambulance to an air ambulance and then from the air ambulance to the final destination hospital. For services prior to 1-1-07, transfer to or from any other type of facility (e.g., skilled nursing facility, nursing home) is not SCT. When billing SCT transports, be sure to include the following information in the Comments field (NTE02) or on the paper claim:

• Information that the patient was discharged from the 1st facility and admitted to the 2nd facility.
• Information to show that is providing care beyond the scope of a paramedic.
• Information to indicate what ongoing care is being provided by a health care professional beyond the scope of a paramedic.

Example:

RN on board IV heparin D/C 1st
ADM 2ndheart cath not available @1st.

*For purposes of SCT payment, CMS considers a “facility” to include only a SNF or a hospital that participates in the Medicare program, or a hospital-based facility that meets CMS’ requirements for provider-based status. Medicare hospitals include, but are not limited to, rehabilitation hospitals, cancer hospitals, children’s hospitals, psychiatric hospitals, critical access hospitals (CAHs), inpatient acute-care hospitals, and sole community hospitals (SCHs). The following origin/destination modifier combinations will be considered for coverage; HH, HN, NH, NN. In addition, the following origin/destination modifier combinations will be considered for coverage when the final destination is hospital or SNF; NI, IN, HI or IH.

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