Get Ambulance Documentation Audit Form - Hcca-info

The Ambulance Documentation Audit Form - Hcca-info is an essential tool for documenting patient transport details accurately. This guide will provide you with straightforward, step-by-step instructions to assist you in filling out the form online.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Enter the date of service in the designated field at the top of the form. This marks the day the patient received transport.
3. Fill in the patient's name, ensuring to include their full name. This identification is crucial for record-keeping.
4. Input the payor information such as the insurance provider or other responsible parties for the transport costs.
5. Indicate the level of service provided by checking the appropriate box, either BLS (Basic Life Support) or ALS (Advanced Life Support), including specific types, if applicable.
6. Document the loaded miles beneath the Level of Service section, as this information is vital for billing purposes.
7. Collect and enter all required patient details, including their address, phone number, and health insurance claim number.
8. Provide the date and time of the transport to create a chronological record of services.
9. State the reason for transport, detailing the patient's complaint or condition to justify the service.
10. Mention if the situation was an emergency or a nonemergency as this affects the nature of the documentation.
11. Include the name of the individual who ordered the transport to validate authorization.
12. Document the patient’s or their representative’s signature, or specify why it was unobtainable, to confirm consent.
13. Describe the patient assessment and provide a chronological narrative of the care and services rendered during transport.
14. Enter the patient's related medical history, if available, to give context to their care during transport.
15. Provide the names and addresses for both the origin and destination of the transport.
16. Record the dispatch instructions that were documented during the transport process for clarity.
17. Fill in the odometer readings at both the origin and destination to track the distance travelled.
18. Note the number of loaded miles to ensure accuracy in service billing.
19. List any specialized services or supplies employed during the transport clearly and itemize them.
20. Document the name of the treating or receiving physician for accountability in patient care.
21. Ensure that names, titles, and signatures of all ambulance personnel involved in the transport are documented.
22. Enter the provider’s vehicle and license plate numbers for identification purposes.
23. Indicate the type of vehicle used (BLS or ALS) for a better understanding of the services provided.
24. Record details for round trips if applicable, documenting each leg of the trip separately.
25. Complete the coding section as necessary to ensure proper billing aligns with the services rendered.
26. Fill out additional sections relevant to co-payment and medical necessity as required for Medicare or other payors.
27. Once all sections are thoroughly completed, save your changes. You can then download, print, or share the completed form as needed.

Complete your Ambulance Documentation Audit Form online today for accurate and efficient record-keeping!