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Changing or Establishing Charges for New Procedures and Care Provided by Nurses on the Inpatient Units (9.01)

Changing or Establishing Charges for New Procedures and Care Provided by Nurses on the Inpatient Units (9.01) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.01

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.01

Original
Revision

Page 1
Of 5

Title: Changing or Establishing Charges for
New Procedures and Care Provided by
Nurses on the Inpatient Units



I. PURPOSE:
A. To provide a consistent mechanism for establishing equitable patient charges on inpatient
units.
II. POLICY & PROCEDURE:
A. Request for the establishment of new charges or changes in established charges must be
addressed first with the Clinical Department Director by the Nurse Manager.
B. The Nurse Manager and Clinical Department Director will work with the Financial
Officer for Nursing and Patient Care Services and the Charge Capture Manager to prepare
written criteria and a recommended price for the proposed new or revised patient charge.
Written criteria will specifically define the patient condition(s) which justify the
additional charge. Depending on the criteria, the charge will be either automated or
manually performed by unit staff. Manual unit-based charging procedures will be
specified in the final policy authorizing the specific charge.
C. When a unit is requesting to apply a charge already existing on one or more inpatient
units, the Clinical Department Director of the unit will send a request to implement the
charge to the Financial Officer for Nursing and Patient Care Services and the Charge
Capture Manager. This type of request needs no additional Nursing Executive Council
(NEC) approval and can be implemented as soon as approved by the Charge Capture
Manager. The Charge Capture Manager informs and works with Information Systems
staff to assure appropriate programming of the charge within the clinical information
system.
D. When a unit is requesting a completely new patient charge, the Clinical Department
Director and Financial Officer for Nursing and Patient Care Services will discuss any
proposed change in practice with the Senior Vice President, Nursing and Patient Care
Services and Charge Capture Manager and will seek approval of the written criteria for
charging.
E. Following approval by the Senior Vice President, Nursing and Patient Care Services, the
proposed new charge will be discussed at an NEC meeting. The NEC will determine if
the proposal should become policy and whether the charge should be applied on any other
unit(s).
F. Following NEC recommendation to proceed with the new charge implementation, the
Financial Officer for Nursing and Patient Care Services will use the approved charge
criteria as the basis for developing a policy to authorize use of the patient charge. Each

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.01

Original
Revision

Page 2
Of 5

Title: Changing or Establishing Charges for
New Procedures and Care Provided by
Nurses on the Inpatient Units



policy will also contain a section outlining the process for charging when that process is a
manual one. The draft policy will be reviewed and approved by the Nursing
Administrative Policy and Procedure Committee.
G. The approved policy will be forwarded to the Charge Capture Manager by the Financial
Officer for Nursing and Patient Care Services. The Charge Capture Manager is
responsible for overseeing the establishment of the charge within the financial systems
and initiating the work of Information Systems staff to assure appropriate programming
of the charge within the clinical information system. Information Systems is responsible
for corresponding with all affected parties upon completion of the charge approval and
setup.
H. The unit manager will orient staff to the approved charging procedures and is accountable
for the accurate and timely recording of patient charges on his/her unit. See Nursing
Administrative Policy 9.00.
III. TYPES OF PATIENT CHARGES on INPATIENT UNITS:
A. Daily Care inpatient charges can include the following:
1. Daily Care Level 1 - basic general care charge if no higher level charge applies
2. Daily Care Level 2 - general care charge for patients in isolation, unless a higher
level charge also applies
3. Daily Care Level 4 – general care charge for patients who meet unit-specific Level
4 charge criteria contained in Nursing Administrative patient charge policies,
unless a higher level charge also applies
4. Daily Care Level 5 – general care charge for patients who meet unit-specific
Level 5 charge criteria contained in Nursing Administrative patient charge
policies and/or for Burn Service patients who are placed on a general care unit,
unless a higher level charge also applies
5. Daily Care Level 6 – general care charge reserved for transplant service patients
and post-transplant patients meeting specified criteria contained in Nursing
Administrative patient charge policy 9.11, unless a higher level charge also
applies
6. Daily Care Level 12 – general care charge for patients with an insulin drip order,
unless a higher level charge also applies.
7. Daily Care 1:1 Non-ICU (also referred to as General Care Singles charge) -
reserved for general care patients meeting the one-on-one nursing care criteria

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.01

Original
Revision

Page 3
Of 5

Title: Changing or Establishing Charges for
New Procedures and Care Provided by
Nurses on the Inpatient Units



specified in Nursing Administrative Policy 9.10, and currently applicable on units
B66 and P4 only
8. Daily Care IMC – Intermediate care charge for patients meeting Intermediate Care
criteria
9. Daily Care ICU -Intensive care charge for patients meeting ICU criteria, unless a
1:1 ICU (ICU- Single) charge also applies
10. Daily Care 1:1 ICU (also referred to as ICU-singles) charge for ICU patients
meeting the one-to-one nursing care criteria specified in Nursing Administrative
Policy 9.03
B. Patient Charge Increments are additions to Daily Care or OSS/OBS charges, and include
the following:
1. Bariatric Patient Increment - for patients who meet the specific charge criteria in
Nursing Administrative Policy 9.02, this Increment charge is added to the
applicable Daily Care or OSS/OBS charge. Note: As of October 2009, there is
just one inpatient Increment charge.
C. Outpatient Charges on inpatient units can include the following:
1. Observation (OBS) - for the patient needing additional evaluation before a
decision to admit as inpatient
2. Outpatient-Short Stay (OSS) - for the scheduled or unexpected patient that is
usually managed in an outpatient/ambulatory setting, but is now receiving care on
an inpatient unit for recovery or administration of a procedure
D. Patient Procedure Charges are unit-specific and include, but are not limited to those listed
below. There are different charging guidelines associated with each procedure charge.
The unit manager is responsible for training staff on their appropriate use. Several of the
procedure charges listed below are bed-side procedures that can be charged to inpatients;
others are charged only to Outpatient Short Stay (OSS) and Observation (OBS) patients
(in addition to the regular OSS or OBS hourly charge.)
1. Bronchoscopy - charged to ICU inpatients, OSS and OBS patients who receive
this service/procedure.
2. Transfusion - charged to OSS and OBS patients who receive this
service/procedure.
3. IV Infusion Therapy- charged to OSS and OBS patients who receive this
service/procedure.

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.01

Original
Revision

Page 4
Of 5

Title: Changing or Establishing Charges for
New Procedures and Care Provided by
Nurses on the Inpatient Units



4. Injection - charged to OSS and OBS patients who receive this service/procedure.
5. Chemotherapy IV and Injection- charged to OSS and OBS patients who receive
this service/procedure.
6. CNS/Reservoir - charged to OSS and OBS patients who receive this
service/procedure.
7. Intraperitoneal Drug(s) - charged to OSS and OBS patients who receive this
service/procedure.
8. VAD (IV Infusion Therapy: Vascular Access Device-Simple (PTV) and Vascular
Access Device-Complex and IV) - charged to OSS and OBS patients who receive
this service/procedure.
9. Spinal Lumbar DX- charged to OSS and OBS patients who receive this
service/procedure.
10. Psych Diagnostic Interview - charged to Psych Unit inpatients who receive this
service/procedure.
11. ECT - charged to Psych Unit inpatients, OSS and OBS patients who receive this
service/procedure.
12. Catheterization of the Right Heart - charged to Cardiac Unit inpatients who
receive the service/procedure.
13. Cardioversion - charged to Cardiac Unit inpatients who receive the
service/procedure.
E. Special order supplies of various types are unit-specific charges and are:
1. Charged to any inpatient, OSS or OBS patients who receive special order supplies
(not from Central Supply Service) in an amount greater than $50.00 during their
inpatient stay. Contact the Charge Capture Manager for specific instructions on
establishing the price for a special order supplies charge.
2. Charged to any inpatient, OSS or OBS patient who receives special order supplies
of any dollar amount for the purpose of taking them home. Contact the Charge
Capture Manager for specific instructions on establishing the price for a special
order supplies charge.

IV. AUTHORED BY:
A. Becky Moore, Financial Officer for Nursing and Patient Care Services


POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.01

Original
Revision

Page 5
Of 5

Title: Changing or Establishing Charges for
New Procedures and Care Provided by
Nurses on the Inpatient Units




V. REVIEWED BY:

A. Amy Armstrong, Manager, Charge Capture, November 2015
B. Fran Schultz, Association Nursing Informatics Specialist, November 2015
C. Nursing Administrative Policy and Procedure Committee, November 2015

SIGNED BY:

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