Review of Emergency Services Provided to Aliens

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Review of Emergency Services Provided to Aliens
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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

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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 2000.

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Review of Emergency Services Provided to Aliens
http//www2.thecarolinascenter.org/Ccme/aliens.ccm
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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

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Review of Emergency Services Provided to Aliens

• Submission of Records
• CCME Toll-Free Fax Number
• 1-866-932-5926
• CCME Mailing Address
• CCME
• 100 Regency Forest Drive
• Suite 200
• Cary, NC 27518-8598
• Attn Alien Emergency Services Review

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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

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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

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

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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?

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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.

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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.
• 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.

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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.
• 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.

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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.

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Review of Emergency Services Provided to Aliens

• Questions?

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Review of Emergency Services Provided to Aliens

• Contact Information
• CCME Toll-Free Telephone
• 1-800-682-9860
• CCME Website
• http//www.thecarolinascenter.org