Patient Signature for Ambulance Transports Guidelines Quiz

Questions and Answers

To comply with HIPAA regulations

To comply with Medicare billing requirements (42 CFR § 424.36) (correct)

To ensure patient consent for treatment

To document patient refusal of medical treatment

Only the beneficiary's legal guardian

A relative or other person who receives social security or other governmental benefits on the beneficiary's behalf

Any healthcare provider involved in the patient's care

All of the above, plus any other person who arranges for the beneficiary's treatment (correct)

To obtain payment for services directly from the hospital

To authorize a provider or supplier to submit a claim to Medicare for specified services (correct)

To confirm hospital admission and patient handoff

To authorize the hospital to release patient information to the fire department

Every 2 years, on January 1st Signup and view all the answers

ePCR Signup and view all the answers

Fire Chief Signup and view all the answers

To enable the Village of Hoffman Estates to receive reimbursement for services Signup and view all the answers

January 1, 2022 Signup and view all the answers

Release for Billing Signup and view all the answers

If no other representatives are available or willing to sign Signup and view all the answers

A signature is not required Signup and view all the answers

The Patient's nurse Signup and view all the answers

Patient Consent Form Signup and view all the answers

First and last name along with a time stamp Signup and view all the answers

Study Notes

Compliance with Medicare 42 CFR § 424.36 - Signature requirements for ambulance billing

CFR – Code of Federal Regulations
ePCR – Electronic Patient Care Report
Patient Representative or Guardian – includes: • Legal guardian • Relative or other person who receives social security or other governmental benefits on the beneficiary's behalf • Relative or other person who arranges for the beneficiary's treatment or exercises other responsibility for his or her affairs • Representative of an agency or institution that did not furnish the services for which payment is claimed but furnished other care, services, or assistance to the beneficiary

Hoffman Estates Fire Department (HEFD) personnel must obtain a beneficiary (patient) signature from all patients transported to a medical facility
Patient signature is required for insurance benefits to be assigned to the Village of Hoffman Estates

Obtain a signature from the Patient (beneficiary), Patient Representative, or Hospital/Receiving Agent to authorize a claim to Medicare
Department members can obtain a signature within the “Signature” section provided in ImageTrend on the ePCR
All attempts should be made to have the patient sign their own claim
Patient is required to sign unless they are deceased, physically or mentally incapable of signing
If patient is physically or mentally unable to sign, a signature must be obtained by an “Patient Representative or Guardian”
If no Patient Representative or Guardian is present, then the Hospital/Receiving Agent may sign on the Patient’s behalf
Ambulance crew is authorized to sign on the Patient’s behalf only if none of the aforementioned individuals were available or willing to sign the claim
A reason must be selected when gathering a signature for a claim
When the Patient or Patient Representative signs the claim, “Release for Billing” must be selected in the “Signature Reason” dropdown box
If the Hospital/Receiving Agent or EMS Crew Member signs the claim, “Billing/HIPAA Acknowledgement” must be selected in the “Signature Reason” dropdown box
All persons signing shall have their first and last names documented along with the time stamp of their endorsement