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

Review of Emergency Services Provided to Aliens

Welcome!Welcome!

Training ObjectivesTraining Objectives

Learn how to submit recordsLearn how to submit records Learn about the review processLearn about the review process Learn what the reviewers look forLearn what the reviewers look for Be able to ask questionsBe able to ask questions

Review of Emergency Services Provided to Aliens

Who is CCME?Who is CCME?The Carolinas Center for Medical The Carolinas Center for Medical

Excellence (CCME) is an independent Excellence (CCME) is an independent non profit corporation. non profit corporation.

Our mission is dedicated to improving Our mission is dedicated to improving the quality and cost effectiveness of the quality and cost effectiveness of

health care. health care.

We have been conducting the Review We have been conducting the Review of Emergency Services Provided to of Emergency Services Provided to

Aliens since 2000. Aliens since 2000.

Review of Emergency Services Provided to Aliens

Review of Emergency Services Provided to Aliens

http://www2.thecarolinascenter.org/Ccme/aliens.ccme

Submission of RecordsSubmission of Records

All MA-2504/3330 Figure 7s and All MA-2504/3330 Figure 7s and accompanying medical records accompanying medical records

must now be sent to CCMEmust now be sent to CCME

Records must be mailed or faxed to Records must be mailed or faxed to CCMECCME

Review of Emergency Services Provided to Aliens

Submission of RecordsSubmission of Records

CCME Toll-Free Fax NumberCCME Toll-Free Fax Number 1-866-932-59261-866-932-5926

CCME Mailing AddressCCME Mailing AddressCCMECCME

100 Regency Forest Drive100 Regency Forest DriveSuite 200Suite 200

Cary, NC 27518-8598Cary, NC 27518-8598Attn: Alien Emergency Services ReviewAttn: Alien Emergency Services Review

Review of Emergency Services Provided to Aliens

Mailing & Handling of CDs/DVDsMailing & Handling of CDs/DVDs Label the disc as “Confidential”Label the disc as “Confidential” Only use a diskette mailer, specifically Only use a diskette mailer, specifically

designed for mailing CDsdesigned for mailing CDs Label the envelope “Confidential: To be Label the envelope “Confidential: To be

opened by addressee only”opened by addressee only” One medical record per CDOne medical record per CD Include hard copy MA-2504/3330 Figure Include hard copy MA-2504/3330 Figure

7 with each disc7 with each disc

Review of Emergency Services Provided to Aliens

The Review ProcessThe Review Process

Search for previous review on same caseSearch for previous review on same case Nurse reviews case, and make Nurse reviews case, and make

recommendation to physicianrecommendation to physician Physician conducts review, and makes final Physician conducts review, and makes final

determinationdetermination Physician documents determination on MA-Physician documents determination on MA-

2504/3330 Figure 7 2504/3330 Figure 7 Completed MA-2504/3330 Figure 7 returned to Completed MA-2504/3330 Figure 7 returned to

countycounty

Review of Emergency Services Provided to Aliens

Missing InformationMissing Information

If the reviewer determines that there is If the reviewer determines that there is missing information, it will result in a missing information, it will result in a

MA-2504/3330 Figure 6BMA-2504/3330 Figure 6B being faxed to the countybeing faxed to the county

Please return the MA-2504/3330 Figure 6B form Please return the MA-2504/3330 Figure 6B form with the missing information to CCMEwith the missing information to CCME

Review of Emergency Services Provided to Aliens

What do the reviewers look for?What do the reviewers look for?

Is the documentation complete?Is the documentation complete? Is the issue life threatening?Is the issue life threatening? Is it a planned procedure?Is it a planned procedure? Is this for testing only?Is this for testing only?

Review of Emergency Services Provided to Aliens

Frequently Asked QuestionsFrequently Asked Questions

What are some of the reasons our requests may What are some of the reasons our requests may get denied?get denied?

Inadequate documentation, care was not an Inadequate documentation, care was not an emergency, care was routine chemotherapy, emergency, care was routine chemotherapy, care was elective, care was routine follow-up care was elective, care was routine follow-up

visit, request was for testing only.visit, request was for testing only.

Review of Emergency Services Provided to Aliens

Frequently Asked Questions (cont.)Frequently Asked Questions (cont.)

Are there instances in which the county DSS staff can Are there instances in which the county DSS staff can approve a request without sending to CCME? approve a request without sending to CCME? Yes.Yes.

1.1. County staff may auto-approve all dates on which County staff may auto-approve all dates on which ongoing hemodialysis is performed as long as all ongoing hemodialysis is performed as long as all other administrative eligibility requirements are other administrative eligibility requirements are met met andand CCME has approved the initial request CCME has approved the initial request and indicated that the county staff may approve and indicated that the county staff may approve any future hemodialysis request for that recipient. any future hemodialysis request for that recipient.

Review of Emergency Services Provided to Aliens

Review of Emergency Services Provided to Aliens

Frequently Asked Questions (cont.)Frequently Asked Questions (cont.)Are there instances in which the county DSS staff Are there instances in which the county DSS staff

can approve a request without sending to can approve a request without sending to CCME? CCME? Yes.Yes.

2.2. For vaginal deliveries, the county may authorize: For vaginal deliveries, the county may authorize: • one day if the day of admission and the day of delivery 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 are the same day, plus one post-partum day for a total of two days. two days.

• Two days if the day of admission and the day of delivery Two days if the day of admission and the day of delivery are consecutive days, plus one post-partum day for a total are consecutive days, plus one post-partum day for a total of three days.of three days.

• One day if the day of admission and the day of delivery One day if the day of admission and the day of delivery are not the same day, and are not consecutive (the day of are not the same day, and are not consecutive (the day of delivery) plus one post-partum day for a total of two days.delivery) plus one post-partum day for a total of two days.

Review of Emergency Services Provided to Aliens

Frequently Asked Questions Frequently Asked Questions (cont.)(cont.)

Are there instances in which the county DSS staff Are there instances in which the county DSS staff can approve a request without sending to can approve a request without sending to

CCME? CCME? Yes.Yes.

3.3. For caesarean section deliveries the county may For caesarean section deliveries the county may authorize a maximum of five days beginning authorize a maximum of five days beginning with the day the section is performed.with the day the section is performed.

Questions?Questions?

Review of Emergency Services Provided to Aliens

Contact InformationContact Information

CCME Toll-Free TelephoneCCME Toll-Free Telephone

1-800-682-98601-800-682-9860

CCME WebsiteCCME Website

http://www.thecarolinascenter.orghttp://www.thecarolinascenter.org

Review of Emergency Services Provided to Aliens