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GUIDELINES FOR IMPROVING THE BILLING PROCEDURES FOR EMS AMBULANCE SERVICES PROVIDED TO RESIDENTS AND PATIENTS RESIDING IN THE NURSING HOMES AND HEALTH CARE UNITS OF ROWAN COUNTY~ EFFECTIVE 1 AUGUST 1991 II. BILLING FOR NURSING FACILITIES AND REST HOMES Nursing facilities and rest homes (hereafter known as the facility) of Rowan County depend to a great degree on the Rowan County Emergency Medical Service for emergency or non-emergencyambulance transportation. While the facility is not the "provider" of such transportation and cannot therefore bill residents/patients directly, they have an obligation to use said services in a reasonable way. It is understood the facility will be billed directly for services rendered by EMS which are not covered under Medicare and which EMS concludes is not collectable from the residents/patients and/or a responsible party. MEDICARE ONLY RESIDENTS/PATIENTS EMS will accept Medicare assignments. When Medicare approves payment the resident/patient at the facility will be responsible for the difference between' the Medicare payment, and the approved amount. The facility will assist EMS in the collection of balance due bills, ff the claim is denied, 'the facility will accept the responsibility for the bill. III. MEDICARE AND THIRD PARTY INSURANCE RESIDENTS/PATIENTS EMS will accept Medicare assignment and will file no additional third party insurance. Third party insurance will be the responsibility of the resident/patient and/or the facility. If there is an outstanding balance after Medicare payments have been received, the patient at the facility will be responsible for any unpaid balance. If the total bill is denied, the facility will accept responsibility for the bill. IV. MEDICAID ONLY RESIDENTS/PATIENTS EMS will accept Medicaid assignments. If the claim is denied, the facility will accept the responsibility for the bill. PHYSICIAN'S STATEMENT When there is a. question of the medical necessity for ambulance transport the facility will assist EMS in getting a completed Physician's Statement. The patient's physician will specify the need for ambulance transportation. This form will enhance Medicare reimbursements. It will also help EMS dete.nine when a facility is abusing the system and should be billed directly for the services.