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Patient Charge Capture Responsibilities on the Inpatient Units (9.00)

Patient Charge Capture Responsibilities on the Inpatient Units (9.00) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.00

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.00

Original
Revision

Page 1
Of 6

Title: Patient Charge Capture
Responsibilities on the Inpatient Units




I. PURPOSE:
A. To provide a consistent process for the appropriate capture of patient charges on inpatient
units.
II. PROCEDURE:
A. Inpatient charges are captured at midnight. Therefore, all appropriate inpatient charges
must be available in the Electronic Health Record (EHR) prior to the midnight charge
capture time.
1. Every inpatient receives a “room” charge called a “daily care charge” which
covers the cost of room and board and nursing standard of care procedures for the
previous 24 hours. Each inpatient is to be charged for the day of admission and
each subsequent day of the stay, except for the day of discharge, which is not
charged. In most cases the inpatient daily care charge is an “all-inclusive” charge.
There are, however, some inpatient charges that are additions to the daily care
charge. Included in this category of additions are the Bariatric Increment charge,
approved bed-side procedure charges, and special order supply charges.
Application of the Bariatric Increment will, in effect, increase the amount of the
daily care room charge. Bed-side procedure and special order supply charges are
billed as separate items.
2. There are several factors that enter into the determination of the correct daily care
charge in the EHR. Those factors include: Patient Class (Inpatient, Outpatient
Short Stay or Observation), Accommodation Code, clinical service designation,
presence of an isolation order, presence of an insulin drip order, patient care unit,
and patient charge criteria per Nursing Administrative Policies. (See attachment
“Components that Determine Daily Care Bed Charges” for details.)
 Accommodation Code warrants further explanation. The physician order
for the patient level of care (General Care, Intermediate Care or Intensive
Care) drives the initial accommodation code entry by the Admissions
Department for an inpatient admission. The initial accommodation code
entry can be modified by the unit staff. This will occur either when the
physician order is changed or when Nursing Administration patient charge
policy criteria are met. (Nursing Administration 9.00 series.) These
policies are available 24/7 in uConnect for use by staff, by searching for
“Patient Charges” in the policy section.

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.00

Original
Revision

Page 2
Of 6

Title: Patient Charge Capture
Responsibilities on the Inpatient Units




3. Upon admission of a patient, the initial accommodation code is entered into the
Electronic Health Record (EHR) by the Admissions Department. Where Patient
Class equals Inpatient, the physician order pertaining to patient status (Gen Care,
IMC or ICU) becomes the basis for selection of the accommodation code.
4. An inpatient daily care charge is then generated by the EHR system based upon
the accommodation code, the clinical service and presence or absence of an
isolation order as of midnight. Inpatient daily care charges can be manually
modified based upon the application of patient charge criteria as specified in
Nursing Administrative policies (9.00 series.) Manual modification of the patient
charge is required for a patient with an insulin drip order. Modification of the
daily care charge is accomplished by changing the accommodation code and/or by
adding the Bariatric Increment charge. Once a particular daily care charge is either
automatically generated or manually modified in the EHR, that daily care charge
remains in effect until either the system generated charge criteria data changes, the
staff manually changes the accommodation code, or the patient is discharged.
There is one exception: the Bariatric Increment charge, if applicable, must be
entered into EHR on a daily basis. This increment charge does not automatically
stay in effect through the date of discharge.
5. Physician orders for a change in the Patient Status will require a manual change to
the patient’s accommodation code in order to produce the correct daily care
charge. For this purpose, the accommodation code choices are General Care, IMC
or ICU. When a physician order to change patient status is received, the
accommodation code will be immediately updated in the EHR by unit staff to
reflect the patient status change. Only unit B45, the universal care unit, has the
authority to apply different criteria for updating the daily care charge per Nursing
Administrative Policy 9.13.
6. Patient charge criteria, as defined by Nursing Administrative policy, are applied at
the unit level. The application of policy criteria may result in the need for unit
staff to update the patient’s accommodation code in the EHR. The following
accommodation codes can be entered into the EHR by nursing unit staff per
Nursing Administrative policy: Level 5, Level 6, and Singled Care. The Bariatric
Increment charge is also applied based upon Nursing Administrative policy
criteria.

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.00

Original
Revision

Page 3
Of 6

Title: Patient Charge Capture
Responsibilities on the Inpatient Units




7. Bed-side procedure charges, if applicable, are entered into the EHR by unit staff
as they occur.
8. Special order medical supplies may be charged to an individual patient only when
those supplies are ordered for the exclusive use by this patient. Where applicable,
these supply charges are entered into the EHR by unit staff as they occur. (See
Policy 9.15 Charging Patients for Medical Supplies Used During a Patient Stay on
an Inpatient Unit.)
B. Outpatient charges (OSS-Outpatient Short Stay & OBS-Observation plus all additional
applicable procedure charges) are captured at the time the outpatient is discharged or the
accommodation code (patient status) is changed from OBS to Inpatient. Therefore, all
appropriate charges must be entered into the EHR at the time the patient is discharged
from outpatient status.
1. Every outpatient (OSS and OBS) receives a charge covering the cost of room and
board and nursing care. Outpatients are charged on an hourly basis. There is one
charge for the first hour plus a charge for each additional hour. The charges run
from the time the outpatient is admitted until the time that discharge criteria are
met. (Frequently the discharge criteria are met before the actual discharge time.)
2. The outpatient room and board charge is not all-inclusive, in that it does not cover
the cost of procedures administered. Outpatient procedures such as infusions,
chemotherapies or injections carry a separate charge and must be specifically
entered into the EHR.
3. The Bariatric Increment charge, if applicable, must be entered into the EHR on a
daily basis.
4. Special order medical supplies may be charged to an individual patient only when
those supplies are ordered for the exclusive use by this patient. Where applicable,
these supply charges are entered into the EHR as they occur. (See Policy 9.15.)
C. The Nurse Manager (NM) is accountable for the accurate and timely recording and
reconciliation of patient charges on his/her unit.
D. The Nurse Manager is responsible for appropriate orientation of unit staff to all pertinent
patient charging procedures. Staff must know which charges are to be used on their unit
and where to find the written criteria for the Bariatric Increment and special daily care
level 5, level 6, 1:1 singled care and any other special patient charge criteria that may
pertain to the unit. In addition, each staff member will understand the unit-based process

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.00

Original
Revision

Page 4
Of 6

Title: Patient Charge Capture
Responsibilities on the Inpatient Units




to be followed for assuring all patient charges in the EHR are correct as of midnight.
E. The Nurse Manager (NM) delegates the responsibility of charge entry to the Health Unit
Coordinator (HUC). When there is not a HUC working on the unit, the responsibility for
charge entry transfers to the Registered Nurse as specified by the NM. The NM will
specify whether this is the Care Team Leader or the Nurse Clinician caring for the patient.
F. The Nurse Manager or assigned delegate will conduct both a daily prospective and a
daily retrospective review of patient charges for the purpose of assuring that all charges
captured are appropriate and that all appropriate charges have been captured.
1. Prospective Review.
 In the EHR, set up Patient List to include, at minimum, the following
columns: Bariatric Charge, Service, Accommodation Code, Isolation, and
Patient Class. Print the Patient List in the morning. Review the data in
those fields listed above to assure it is complete and correct for each
patient.
 Review the symbols in the Bariatric Charge column and determine if the
patient qualifies for the Bariatric Increment based on BMI and whether the
associated documentation requirements have been completed within the
last 24 hours. If the patient qualifies for the Bariatric Increment and the
documentation criteria has not been met within the last 24 hours, follow-
up with the patient’s nurse to determine whether the Bariatric Increment
needs to be applied (See Policy 9.02 Criteria for Bariatric Increment
Charge.)
 Review the HUC Follow-Up Tasks report in HL to determine if any
Insulin Orders Needing Accommodation Code Change have been written
for the patient. If new or discontinued orders are indicated in the report,
update the Accommodation Code as indicated in the task and complete the
task. Determine if any patient should receive a different accommodation
code based upon meeting criteria in Nursing Administrative patient care
charge policies. (See patient care charging policies covering Level 5
charging criteria.)
 Assure that nurses caring for OSS/OBS patients are appropriately
documenting on the OSS/OBS paper documentation form.
 Assure that all patient charges in the EHR are currently appropriate based

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.00

Original
Revision

Page 5
Of 6

Title: Patient Charge Capture
Responsibilities on the Inpatient Units




upon this prospective review. Circumstances that lead to patient charges
can change during the day.
2. Assure that all HUC and RN staff members are aware of circumstances that lead
to patient charges and that any changes affecting patient charges that occur after
the prospective review are accurately reflected in the EHR before midnight.
Retrospective Review.
 In Health Link, print the Revenue and Usage report. This report lists all
charges that were captured for each inpatient as of midnight and for each
outpatient as of their discharge date.
 Assure that all patient charges as they appear on the Revenue and Usage
report are correct.
 Compare the list of patients in the Revenue and Usage report to the list of
patients on the Census Snapshot report in the EHR to assure that all
patients on the unit are also reflected in the Revenue and Usage report.
 If incorrect patient charges are discovered, immediately enter corrections
into the EHR if the patient is not yet discharged. If patient needing a
charge correction has been discharged, then call the Admissions
Department to report the error.
 pon the discharge of outpatients, assure that all outpatient (paper)
documentation forms have been completed correctly and included in the
medical record.
IV. REVIEWED BY:
A. Financial Officer for Nursing and Patient Care Services, September 2015
B. Manager. Charge Capture, September 2015
C. Nursing Informatics, September 2015
D. Nursing Administrative Policy and Procedure Committee, September 2015

V. References:
A. Nursing Administrative Policy 9.13, Inpatient Daily Care Charges for the CT-Surgery
Acuity Adaptable Unit
B. Nursing Administrative Policy 9.05, Criteria for Inpatient Daily Care Level 5 Charge
Spinal Cord Injury Patients
C. Nursing Administrative Policy 9.02, Criteria for Bariatric Increment Charge on Adult and

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.00

Original
Revision

Page 6
Of 6

Title: Patient Charge Capture
Responsibilities on the Inpatient Units




Pediatric Inpatient Units

VI. ATTACHMENT: Components that Determine Inpatient Daily Care Bed Charges (Excel
Spreadsheet)


SIGNED BY:

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services,
Chief Nursing Officer