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Criteria for Bariatric Increment Charge on Adult and Pediatric Inpatient Units (9.02)

Criteria for Bariatric Increment Charge on Adult and Pediatric Inpatient Units (9.02) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.02

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.02

Original
Revision

Page 1
Of 4

Title: Criteria for Bariatric Increment Charge
on Adult and Pediatric Inpatient Units



I. PURPOSE
A. Patients will be charged a higher daily care rate when they are admitted to selected
inpatient units and meet criteria as specified in the Policy section below.
II. POLICY
A. Patients that meet the defined criteria will be charged an incremental rate in addition to
the Daily Care charge or in addition to the Outpatient Short Stay (OSS) or the
Observation (OBS) charge, due to their functional status related to their obesity and the
number of staff required at a given time to assist these patients.
B. Criteria for Incremental Bariatric Charge (Must have both present to qualify for this
incremental charge)
1. Patient has a BMI greater than 35, and may or may not have co morbidities, AND
meets one of the two criteria listed in 2. immediately below:
2. a) Requires the assistance of 3 or more staff for mobility
- or –
b) Requires the use of a patient lift or transfer device plus the assistance of 2 or
more staff for mobility
C. The Bariatric Increment charge is an add-on to any Daily Care charge (including ICU 1:1,
ICU, IMC, General Care 1:1, Level 6, 5, 4, 2, or 1). The Bariatric Increment charge is
also and add-on to any Outpatient charge (OSS or OBS.) Patients are charged for each
day they meet the charge criteria. (Note: Inpatients are charged for the day of admission
but not for the day of discharge from the hospital.)
III. PROCESS
A. Upon Admission:
1. Upon admission to the hospital all patients will be evaluated for equipment
needs. (See attached listing of equipment for weight limit/size information.)
2. If equipment is needed, the nurse will notify the Health Unit Coordinator (HUC)
or Patient Care Technician (PCT), who will enter the request for equipment into
the Electronic Medical Record (EMR).
3. Upon admission to the hospital all adult patients will have a BMI documented in
Health Link. The BMI is calculated in the EMR by entering the patient height and
weight. The BMI is updated each time a new height or weight is entered.
4. If the BMI is greater than or equal to 35, the nurse will assess the patient's ability
to assist in transferring and Activities of Daily Living (ADL's) and their ability to
safely turn in the standard hospital bed. If a patient cannot turn safely in the

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.02

Original
Revision

Page 2
Of 4

Title: Criteria for Bariatric Increment Charge
on Adult and Pediatric Inpatient Units



standard hospital bed, a Bariatric bed will be ordered. If the patient requires
pressure relief, an overlay should also be ordered. Any patient that is over 500
pounds will have a Bariatric commode ordered from Central Supply (CS).
5. If patient meets both of the criteria listed in II.B. above then he or she should
receive a Bariatric Increment charge, in addition to any other Daily Care, OSS or
OBS charge. The admitting Nurse will communicate to the HUC the need to
implement the Bariatric Increment charge. The HUC will enter the Bariatric
Increment charge into the HL Charge Navigator before midnight on the day of
admission. The Bariatric Increment charge will remain effective in HL for one day
only, and therefore must be re-entered before midnight for each day in which the
charge is applicable.
6. If the Bariatric Increment criteria are met, the following items must be
documented in the Daily Care Flowsheet in the EMR:
a. Bed Mobility
i. Total Staff Involved with Bed Mobility is equal to 3 or 4.
ii. If Total Staff Involved with Bed Mobility is equal to 2 then Equipment
Used for Bed Mobility must indicate any response except bed rails,
head of bed elevated, not needed or other.
b. Transfer
i. Total Staff Involved with transfer is equal to 3 or 4
ii. If Total Staff Involved with Transfer is equal to 3 the Equipment
Used for Transfer must indicate any response except “not needed”
or “other”
c. Ambulation
i. Total Staff Involved with ambulation is equal to 3 or 4
ii. If Total Staff Involved with ambulation is equal to 2 the Assistive
Gait Device must indicate any response except “not needed” or
“other”
7. It is the responsibility of each Nurse Manager to specify which staff member is
accountable for charge entry when a HUC/PCT is not working. Generally, the task
of assuring correct charges are reflected in the system will be assigned to either
the Care Team Leader or the admitting Nurse when a HUC/PCT is not available.
The assigned staff member is responsible for entering the Bariatric Increment into
Health Link.

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.02

Original
Revision

Page 3
Of 4

Title: Criteria for Bariatric Increment Charge
on Adult and Pediatric Inpatient Units



8. The defining criteria for a Bariatric Increment charge will be available 24/7 on
uConnect for use by staff.
B. Days Following Admission Date:
1. Inpatient Unit management and HUC staff will set up the EMR Patient List to
include the Bariatric Charge Column.
2. Each day symbols in the Bariatric Charge Column will be evaluated to determine
if the patient qualifies for the Bariatric Increment based on BMI. For every patient
with BMI greater than 35, the Bariatric Criteria Patient List Report will be
reviewed to determine if the documentation to support the Bariatric Increment has
been completed within the last 24 hours. The HUC/PTC will follow-up with the
patient’s nurse to determine whether the Bariatric Increment needs to be applied.
3. It is the responsibility of the HUC/PCT (or the manager’s designee) to enter the
Bariatric Increment charge into the EMR Charge Navigator before midnight on
each day in which the charge criteria are met.
C. Daily Patient Charge Review:
1. On a daily basis, the Manager or Manager’s delegate (e.g. Care Team
Leader/STM or HUC/PCT) is responsible for reviewing all active charges before
midnight and for assuring that all patient charges are correct for the midnight
charge capture. All criteria data pertinent to the Bariatric Increment documented
by the nurse is available on the Bariatric Criteria Patient List report in the EMR.
2. On a daily basis, the Manager or Manager’s delegate (e.g. Care Team
Leader/STM or HUC/PCT) must review the Revenue and Usage Report which
lists all charges posted for a patient the previous midnight. A comparison of the
Revenue and Usage Report with the unit census snapshot run for the previous 24
hours will be conducted. Any patient charge errors discovered as a result of this
review will be corrected immediately. If the patient is not yet discharged,
corrections can be made in the EMR by the unit staff. If the patient has been
discharged by the time the error is discovered, the unit staff will notify the
Admissions Department. Admissions will then correct the charge error when
feasible to do so.

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 #:
9.02

Original
Revision

Page 4
Of 4

Title: Criteria for Bariatric Increment Charge
on Adult and Pediatric Inpatient Units



V. REVIEWED BY
A. Fran Schultz, Nursing Informatics, November 2015
B. Amy Armstrong, Manager, Charge Capture, November 2015
C. Nursing Administrative Policy & Procedure Committee, November 2015


SIGNED BY:

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