Patient Services Charges

1. Patient Services Charges Recovering Revenue

2. Place Charges Here But Not There? Charge On General Care Units Don’t Charge On ICUs or Intermediate (Step Down) Units CCU, 10A RICU, MICU SICS, TICU, 5ISC 6INC CTIC, ICTU These units have telemetry and pulse oximetry built into their room charge. You do need to charge for Incentive Spirometry if ordered. You will need to charge for “Pt Type” “Y” (Boarders) on these units. • All Co-op units • All Jane Brown units • 9A, 8B, 8A, 6B, 6A, 4A, 4AE (if being used as a holding unit or housing a general unit) • These units do not have telemetry or pulse oximetry charges built into their room charge. You must also charge for incentive spirometry if ordered.

3. What, When and Who? What items are charged? When are they charged? One time when initial order is written. Charged by transcribing US When initial order is written. Charged by transcribing US and daily by night US until order discontinued. When initial order is written. Charged by transcribing US and daily by night US as long as patient on telemetry. • Incentive Spirometer • Pulse Oximetry • Cardiac Monitoring (Telemetry)

4. Patient Services Charges Report • Prints a few minutes after midnight on each unit. • Lists any orders on the unit for pulse oximetry, cardiac monitoring (telemetry). • The night Unit Secretary uses the report to place daily charges. The charges placed by the night US from the report are for new day as of midnight not the previous day. • Prints on all units, including ICUs and Step Downs where charges for these items are in the room charge. Patients with a “Pt Type” “Y” for “Boarder” will be the only patients charged on these units. • After the charges have been placed the night US attaches the “Patient Services Charge Report” to the “Patient Services Charge Slips” and leaves in the “Patient Services Charges” file box to be picked up by Support Services.

5. How Do Orders Get To The Patient Services Charges Report? • In P.O.M. every ordering screen is attached to a “service code” (Behind the scenes). • The report is programmed to print orders placed by using screens with particular “service codes”, such as pre-typed orders for “Pulse Oximetry” and “Cardiac Monitoring (Telemetry)”. Therefore, if a “Treatment Other” order is used and Cardiac Monitor or Pulse Ox is manually typed in, then this will not pull to the nightly report.

6. Oxygen Orders • Service codes for “Oxygen "orders are also programmed to pull to the report, but we do not charge for the oxygen use. • We do charge for the pulse oximetry that could be ordered in the comment of the oxygen order. • An example would be “oxygen 2 liters, keep 02 saturation at 93%, wean O2 sat to 92%”. • If the order is for any type of oxygen only, we cannot charge for pulse oximetry.

7. The Role of the Transcribing US? • When the transcribing US receives the Order Session print with an order for “Cardiac Monitoring/Telemetry” or “Pulse Oximetry” they need to check if the order was entered by using a pre-typed screen. This can be recognized by looking at how the order was entered. • If the order is “tele”or “monitor”, then it is evident a pre-typed screen was not used. The pre-typed screen says “Cardiac Monitoring/Telemetry”. • If the order is “pulse ox”or“pox”, then it is evident a pre-typed screen was not used. The pre-typed screen says “Pulse Oximetry”.

8. What Else Does the Transcribing US Do? • If orders are entered incorrectly for pulse oximetry or cardiac monitoring, the transcribing US needs to re-enter the order using the pre-typed screen. The same ordering doctor will be used and the same duration. • The transcribing US also needs to place the first charge. Since the night US is charging for the next day, if the first charge is not placed that means lost revenue. • Also place the charge for any Incentive Spirometry orders. Since this is only a one time charge it never prints on the Patient Services Charges Report. If the transcribing US does not place this charge that means more lost revenue.

9. The Role of the Night Shift US • Uses the Patient Services Charges report to place daily charges for pulse ox and cardiac monitor/telemetry. • Places charges for the date as of 00:01, not the previous date.

10. What Else Does the Night Shift US do? • Checks the telemetry monitors: Does each patient on a monitor have an order on the Patient Services Charge Report? If does not have an order on the Patient Services Charge Report checks the Rounds Report to see if the order was entered incorrectly. If so corrects order. If does not have an order-notify nurse or MD an order needs to be placed for the cardiac monitor. Is each patient on the Patient Services Charges Report with an order for Cardiac Monitoring on a monitor? If the patient has an order but is not on a cardiac monitor then notify the nurse or MD to discontinue the order.

11. ORDERS CHARGES One time charge only by transcribing US. Single pulse ox with quantity of 1 or 2 Continuous pulse oximetry Cardiac Monitor/Telemetry No charge 1 single pulse ox • Incentive Spirometer 10x/hr while awake • Single pulse oximetry, pulse ox 2 x/day. • Continuous pulse ox, pulse ox q shift, pulse ox 3 or more x/day. • Cardiac Monitoring/Telemetry • Oxygen 2 liter nc • Oxygen 2 liters nc (wean or keep o2 sat @ 93%)