Review of Emergency Services Provided to Aliens. Welcome! Training Objectives  Learn how to submit records  Learn about the review process  Learn what.

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Presentation transcript:

Review of Emergency Services Provided to Aliens

Welcome! Training Objectives  Learn how to submit records  Learn about the review process  Learn what the reviewers look for  Be able to ask questions Review of Emergency Services Provided to Aliens

Who is CCME? The Carolinas Center for Medical Excellence (CCME) is an independent non profit corporation. Our mission is dedicated to improving the quality and cost effectiveness of health care. We have been conducting the Review of Emergency Services Provided to Aliens since Review of Emergency Services Provided to Aliens

Submission of Records All MA-2504/3330 Figure 7s and accompanying medical records must now be sent to CCME Records must be mailed or faxed to CCME Review of Emergency Services Provided to Aliens

Submission of Records CCME Toll-Free Fax Number CCME Mailing Address CCME 100 Regency Forest Drive Suite 200 Cary, NC Attn: Alien Emergency Services Review Review of Emergency Services Provided to Aliens

Mailing & Handling of CDs/DVDs  Label the disc as “Confidential”  Only use a diskette mailer, specifically designed for mailing CDs  Label the envelope “Confidential: To be opened by addressee only”  One medical record per CD  Include hard copy MA-2504/3330 Figure 7 with each disc Review of Emergency Services Provided to Aliens

The Review Process  Search for previous review on same case  Nurse reviews case, and make recommendation to physician  Physician conducts review, and makes final determination  Physician documents determination on MA- 2504/3330 Figure 7  Completed MA-2504/3330 Figure 7 returned to county Review of Emergency Services Provided to Aliens

Missing Information If the reviewer determines that there is missing information, it will result in a MA-2504/3330 Figure 6B being faxed to the county being faxed to the county Please return the MA-2504/3330 Figure 6B form with the missing information to CCME Review of Emergency Services Provided to Aliens

What do the reviewers look for?  Is the documentation complete?  Is the issue life threatening?  Is it a planned procedure?  Is this for testing only? Review of Emergency Services Provided to Aliens

Frequently Asked Questions What are some of the reasons our requests may get denied? Inadequate documentation, care was not an emergency, care was routine chemotherapy, care was elective, care was routine follow-up visit, request was for testing only. Review of Emergency Services Provided to Aliens

Frequently Asked Questions (cont.) Are there instances in which the county DSS staff can approve a request without sending to CCME? Yes. 1.County staff may auto-approve all dates on which ongoing hemodialysis is performed as long as all other administrative eligibility requirements are met and CCME has approved the initial request and indicated that the county staff may approve any future hemodialysis request for that recipient. Review of Emergency Services Provided to Aliens

Frequently Asked Questions (cont.) Are there instances in which the county DSS staff can approve a request without sending to CCME? Yes. 2. For vaginal deliveries, the county may authorize: one day if the day of admission and the day of delivery are the same day, plus one post-partum day for a total of two days.one day if the day of admission and the day of delivery are the same day, plus one post-partum day for a total of two days. Two days if the day of admission and the day of delivery are consecutive days, plus one post-partum day for a total of three days.Two days if the day of admission and the day of delivery are consecutive days, plus one post-partum day for a total of three days. One day if the day of admission and the day of delivery are not the same day, and are not consecutive (the day of delivery) plus one post-partum day for a total of two days.One day if the day of admission and the day of delivery are not the same day, and are not consecutive (the day of delivery) plus one post-partum day for a total of two days.

Review of Emergency Services Provided to Aliens Frequently Asked Questions (cont.) Are there instances in which the county DSS staff can approve a request without sending to CCME? Yes. 3.For caesarean section deliveries the county may authorize a maximum of five days beginning with the day the section is performed.

Questions? Review of Emergency Services Provided to Aliens

Contact Information CCME Toll-Free Telephone CCME Website Review of Emergency Services Provided to Aliens