Patient Signature for Ambulance Transports Guidelines Quiz

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Questions and Answers

What is the primary reason for obtaining a patient signature for ambulance transports?

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

Who is considered a Patient Representative or Guardian?

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)

What is the purpose of obtaining a signature from a Hospital/Receiving Agent?

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

What is the frequency of re-evaluation for this Standard Operating Guideline?

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

What is the term for the electronic document used to record patient care?

ePCR Signup and view all the answers

Who is responsible for approving Standard Operating Guidelines?

Fire Chief Signup and view all the answers

What is the purpose of assigning insurance benefits to the Village of Hoffman Estates?

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

What is the effective date for this Standard Operating Guideline?

January 1, 2022 Signup and view all the answers

What must be selected as the reason when a Patient or Patient Representative signs the claim?

Release for Billing Signup and view all the answers

In which situation would the ambulance crew be authorized to sign on the patient's behalf?

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

What happens if a patient is deceased regarding the signature requirement?

A signature is not required Signup and view all the answers

Who is typically responsible for signing on behalf of a patient if no Patient Representative or Guardian is present?

The Patient's nurse Signup and view all the answers

Which of the following is NOT a reason for selecting a signature when obtaining a claim?

Patient Consent Form Signup and view all the answers

What must be documented when a person signs on behalf of a Patient?

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

Study Notes

Patient Signature Requirement for Ambulance Transports

Purpose

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

Definitions

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

Policy

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

Procedure

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

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Description

Test your knowledge on the standard operating guidelines for patient signature requirements during ambulance transports, based on the Hoffman Estates Fire Department's SOPs.