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Inpatient Daily Care Charges for the CT-Surgery Acuity Adaptable Unit (9.13)

Inpatient Daily Care Charges for the CT-Surgery Acuity Adaptable Unit (9.13) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.13

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.13

Original
Revision

Page 1
Of 4

Title: Inpatient Daily Care Charges for the
CT-Surgery Acuity Adaptable Unit



I. PURPOSE:
A. Patients will be charged appropriately for the level of care received on the CT-Surgery
Acuity Adaptable Unit.

II. POLICY
A. Each patient with a patient class of "Inpatient" receives a Daily Care charge for each day
of the stay, excluding the day of discharge. Daily Care charges for the CT-Surgery Acuity
Adaptable Unit are based upon a review of the patient status (level of care as ordered by
the physician), the applicable clinical service, and the application of Nursing
Administration Policy criteria related to patient charges. The combination of these three
factors will determine the appropriate accommodation code to be assigned to the patient
on a daily basis. For an inpatient, the level of care is either General Care, Intermediate
Care or Intensive Care; with General Care being the lowest level and Intensive Care being
the highest level. The level of care is entered into the Electronic Medical Record (EMR)
as the accommodation code. The accommodation code plus the clinical service will
together result in a particular daily care charge. (See attachment to Policy 9.00 -
Components that Determine the IP Daily Care Bed Charges.) The accommodation code
can be modified to reflect the application of Nursing Administrative policy criteria. (For
example, a General Care Accommodation code can be upgraded to a Level 5 or Level 6 if
Nursing Policy criteria are met. An ICU accommodation code can be upgraded to Singled
Care if nursing Policy criteria are met.)
For the purpose of patient charging, each day runs from 12:01 am though 11:59 pm. At
12:00 midnight the appropriate charges for the previous 24 hour period from 12:01 -
11:59 are captured for patient billing based on the accommodation code and clinical
service listed for the patient. The appropriate accommodation code for the day of
admission and each subsequent day of the patient stay is explained in Section III. Process.
B. Outpatient charges are posted for patients where the patient class equals either
"Outpatient Short Stay" (OSS) or "Observation" (OBS.) OSS and OBS charges, plus any
related procedure charges are captured for patient billing at the time of discharge or
patient class change from OSS or OBS to Inpatient. Outpatient charging on the Acuity
Adaptable Unit is identical to outpatient charging on every other inpatient unit.

III. PROCESS:
The process used to assign an accommodation code to an inpatient on the CT Surgery Acuity
Adaptable Unit differs from the process used by other inpatient units. When a physician orders a
change to the level of care status for an inpatient, all units except CT Surgery Acuity Adaptable
are required to change the accommodation code immediately to reflect this change in level of

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.13

Original
Revision

Page 2
Of 4

Title: Inpatient Daily Care Charges for the
CT-Surgery Acuity Adaptable Unit



care, with the intention that the patient will be moved to a more appropriate unit before
midnight. Patients on the Acuity Adaptable Unit are not transferred to a different inpatient unit
upon a change order pertaining to their level of care. Therefore, on the CT Surgery Acuity
Adaptable Unit, a 24-hour review of patient level of care is required to determine which
accommodation code should be in place for the midnight charge capture.
A. Assignment of an Accommodation Code on the CT Surgery Acuity Adaptable Unit:
1. If an inpatient is admitted between 4:01 pm and 12:00 midnight, the level of care
as ordered as of 12:00 midnight (General Care, Intermediate Care or Intensive
Care) in conjunction with the admitting clinical service and any applicable
Nursing Administrative Policy charge criteria are used to determine the
appropriate 12:00 midnight accommodation code to be entered and present in the
EMR.
2. If an inpatient is admitted between 12:01 am and 4:00 pm, then the highest level
of care (General Care, Intermediate Care or Intensive Care) attained for a
sustained 8-hour or longer period in conjunction with the admitting clinical
service and any applicable Nursing Administrative Policy charge criteria are used
to determine the appropriate 12:00 midnight accommodation code to be entered
and present in the EMR. (Note, the ICU Singles charge criteria is based on a 4-
hour time period rather than an 8-hour time period.)
3. For each subsequent day of the patient stay, the highest level of care (General
Care, Intermediate Care or Intensive Care) attained for a sustained 8-hour or
longer period between 12:01 am and 11:59 pm in conjunction with the clinical
service and any applicable Nursing Administrative Policy charge criteria are used
to determine the appropriate 12:00 midnight accommodation code to be entered
and present in the EMR. (Note, the ICU Singles charge criteria is based on a 4-
hour time period rather than an 8-hour time period.)
4. As a practical method for keeping current with physician orders to changes in the
patient level of care:
a. Physician order changes that increase the level of care will be reflected by
an immediate change to the accommodation code.
b. Physician order changes that decrease the level of care will not be reflected
immediately.
c. All physician order changes to the patient level of care are reviewed at or
around 8:00 am and 6:00 pm to assure the appropriate accommodation
code was captured the previous midnight and is in place for the upcoming
12:00 midnight charge capture.
B. Additional Inpatient Charges:

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.13

Original
Revision

Page 3
Of 4

Title: Inpatient Daily Care Charges for the
CT-Surgery Acuity Adaptable Unit



1. The Bariatric Increment charge pertains to this unit just as it does to every other
inpatient unit. (The Bariatric Increment must be added each day the criteria are
met by entering the charge through the HL Charge Navigator. This Increment
charge does not automatically stay in effect until discontinued.)
2. The following bed-side procedures will be charged to inpatients on this unit, in
addition to the daily care charge:
a. Bronchoscopy
b. Perchutaneous Tracheostomy
C. Responsibilities Related to Patient Charging
1. Admission:
Upon admission to the CT Surgery Acuity Adaptable Unit there will be an
accommodation code entered into HL by the Admissions Department. The Care
Team Leader (CTL) or nurse caring for the patient (as specified by the Nurse
Manager (NM)) must inform the Health Unit Coordinator (HUC) if there are
applicable Nursing Policy criteria that will alter the accommodation code of the
patient. The HUC is responsible for updating the accommodation code in the
EMR. The NM will specify who is responsible for this function when a HUC is
not working.
2. Following Admission:
a. It is the responsibility of the CTL or nurse caring for the patient (as
specified by the NM) to inform the HUC of any changes in patient status
or condition that require an update to the accommodation code. The HUC
is responsible for updating the accommodation code in the EMR. The NM
will specify who is responsible for this function when a HUC is not
working.
b. All patient charge related information contained in the EMR system will
be reviewed twice daily on this unit, at approximately 8:00 am and 6:00
pm, to assure the patient level of care and other pertinent information is
appropriate for charge capture.
c. On a daily basis, the NM or Manager's delegate (e.g. CTL/Senior Team
Member (STM) or HUC) 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, as well as any additional pertinent
unit-based logs or other information, 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

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.13

Original
Revision

Page 4
Of 4

Title: Inpatient Daily Care Charges for the
CT-Surgery Acuity Adaptable Unit



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.
D. Application of Nursing Administrative Policies Pertaining to Patient Charges
1. All Nursing Administrative Policies pertaining to patient charges (9.00 series)
apply to this CT Surgery Acuity Adaptable Unit except as expressly provided in
this policy. The intent of this policy is to provide for charging patients for the
Intensive and Intermediate levels of care they receive, even if that higher level of
care is not in effect at 12:00 midnight when charges are captured.

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


V. REVIEWED BY
A. Amy Armstrong, Manager, Charge Capture, November 2015
B. Nurse Manager, CT Surgery Acuity Adaptable Unit
C. Fran Schultz, Nursing Informatics, November 2015
D. Nursing Administrative Policy & Procedure Committee, November 2015


SIGNED BY:

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