MedPartners hospital staffing

Medical Necessity* is likely:

  • Is being discharged to a skilled nursing facility
  • Meets “bed confined status:

Unable to get-up from bed without assistance

Unable to ambulate, and

Unable to sit in a chair or wheelchair

  • Has at least one other commonly documented medical necessity condition

Medical necessity is possible, but patient condition must be thoroughly documented:

  • Is being discharged to a skilled nursing facility
  • Does not meet bed confined status
  • Has a least two other commonly documented conditions that legitimately prevent the patient from being transported via wheelchair van or private car:

Specific diagnosis/conditions and their associated signs/symptoms, and how the patient is presently affected

Medical necessity is unlikely:

  • Is being discharged to an assisted living facility
  • Is being discharged to an independent living facility
  • Is being discharged to a residence
  • Is not being placed in a “hospital-style” bed upon their arrival at the destination
  • Is not expected to use a bedpan or bedside commode
  • Is not receiving 24/7 in-home care
  • Poor documentation and/or patient condition descriptions, such as:

Ambulatory dysfunction

Weakness

Medical necessity may be met on a case-by-case basis

  • Requires oxygen
  • Has Dementia, Alzheimer’s Disease, or a Traumatic Brain Injury, or other conditions that prevent the patient from being conscious, alert, and oriented; or, patient could accidentally self-harm without an attendant
  • Is being discharged to an assisted living facility that has a locked memory care unit

Medical necessity will not be met

  • Needs a stretcher for logistical purposed only, examples include:

Can not climb steps

Can not ambulate without assistance

Arrived at emergency department via ambulance

Pulse medical transportation, www.pulseMT.com

*Medical necessity is defined as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”

Medicare.com

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