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UWHC,

Policies,Administrative,UWHC,UWHC-wide,Fiscal

Charging System & Process for Charge Entry/Reconciliation for all UWHC Clinical Areas That Charge a Facility Fee (2.14)

Charging System & Process for Charge Entry/Reconciliation for all UWHC Clinical Areas That Charge a Facility Fee (2.14) - Policies, Administrative, UWHC, UWHC-wide, Fiscal

2.14


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Administrative (Non-Clinical) Policy
Category:
 UWHC only (Hospital Administrative-entity wide)  UWMF only (entity wide)
 UWHC Departmental (indicate name)  UWMF Departmental (indicate name)
 UWHC and UWMF (shared)
Policy Title: Charging System & Process for Charge Entry/Reconciliation for all
UWHC Clinical Areas That Charge a Facility Fee
Policy Number: 2.14
Effective Date: July 1, 2015
Chapter: Fiscal
Version: Revision
I. PURPOSE

To define a consistent system for charging and a charge entry process to assure accurate, complete and
timely charging of the hospital facility fee for all clinical areas that generate a facility fee.

II. POLICY

There must be a hospital (technical or facility) charge for all services provided. Charges and diagnosis
will be entered on the day of service or within no more than 24 hours. A charge must be entered for all
services performed/delivered. Any requests to remove or eliminate charges must be communicated to the
UWHC Patient Business Services. Corrections of mistakes can be completed by the staff that made the
entry. A reconciliation/audit process will be used daily to assure that all charges are complete and
accurate.

See also: Hospital Administrative Policy 2.12-UWHC Billing Policy

III. DEFINITIONS
A. Routine Clinic Visit Fee - This fee incorporates the hospital paid support staff direct care time
increments, including RN, MA/NA, LPN, Social Worker, Pharmacist, Dietitian and Exercise
Physiologist, total direct care time in exam room with all providers (e.g. MD, Fellow, Resident,
Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants) and support staff.
(NOTE: effective March, 2005, the UW Medical Foundation assumed billing responsibility for
professional services provided by most hospital NP/CNS/PA's. Therefore, NP/CNS/PA direct
care time increments are not included in the calculation of the clinic visit fee.) There are four tiers
of charges based upon the complexity of direct and indirect care. All clinics with similar services
have been placed in one of these tiers to assure similar charges for similar care, regardless of site.
B. Multi-disciplinary Clinic Visit Fee - A multi-disciplinary visit includes 3 or more Health care
professionals, one of which is a faculty physician. Other professionals can include NP, CNS,
Physician Assistant, SW, Pharmacist, Dietitian, Psychologist, etc. The pre-operative work-up is
not considered a multidisciplinary visit. The fee for a multi-disciplinary visit is a set fee and is not


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affected by time units or room usage time. Time units and room usage time still need to be
collected to complete this charge.
C. Procedure Fee - A fee based upon the total direct patient care time provided during the procedure
by all providers. The procedure fee includes room usage fee, labor, usual supplies, and equipment
used. Expenses such as support staff time required for procedure set up, clean-up, and
transportation if applicable are considered. Examples of procedures are ear irrigations,
catheterizations, injections, intravenous infusions and medical procedures using hospital
equipment. A clinic visit fee is not charged if the patient is scheduled specifically for a procedure
only. If the procedure is added during the visit, both may be charged.
D. Research Visit Fee - The regular clinic visit fee is used for research visits. The price of research
visits is governed by Hospital Administrative policy 2.13-UWHC Charges for Patients in
Research Studies.
IV. PROCEDURE
A. Routine Clinic Visit Charges:
1. Indicate the number of time units of direct care provided by personnel employed by the
hospital. Each time unit is equal to 15 minutes. Time units are determined by rounding up
to the nearest unit. (Example: 5 minutes = 1 time unit; 20 minutes = 2 time units). Each
staff member should check off their time units in their appropriate category, e.g. RN,
MA/NA, Social Worker. The total of all time units will be entered to generate the clinic
visit fee.
2. Indicate room usage time by estimating the total direct care time of all support staff and
health care professionals, including the physician. Do not include wait time. Check the
time category that most closely reflects total time in room during which direct care was
given: 0-15minutes; 16-45 minutes; or greater than 45 minutes.
3. The following activities should not be included in the time units or room usage categories
for Routine or NP/CNS/PA Clinic Visits:
a. Patient waiting in exam room when no care is being provided
b. Chaperoning for pelvic or other exam
c. Sitting with a patient waiting for their driver or cab when escort staff or a
volunteer is not available
d. Escorting patients to x-ray or lab
e. Procedure charges
f. Time in transit to and from procedures. This should be already included in the
procedure charge
g. Each health care provider and support staff, who indicates a time unit, must
document and sign the note in the medical record indicating the care provided or
assessment obtained
B. Advanced Practice Nurse/Provider (NP/CNS/PA) Visit Charges
1. Indicate room usage time by estimating the total direct care time as defined above. Do not
include wait time. (Note: NP/CNS/PA labor is billed by UWMF).
C. Multidisciplinary Visit Fee
1. Indicate the number and types of licensed professionals involved in the visit. All health
care providers must document their assessment and care provided and sign a note in the
medical record.
D. Procedures Performed in Clinics
1. Procedures performed in clinics will have set charges defined by each clinic in
conjunction with Fiscal Affairs and Business Planning and Analysis, based upon the
definition above.


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2. Time involved in procedures should not be included in the clinic visit time units or visit
room usage estimate. Some procedure charges are based on incremental time units
specific to that procedure.
3. A clinic visit fee will not be charged if the patient is scheduled for a procedure only. If
the procedure is added during a visit, both a clinic visit fee and procedure fee can be
charged.
4. Each Clinic must have a Procedure Charge Preference List which defines the specific
procedures for that clinic and is used as the reference for all employees to assure accurate
charging.
E. Research Visit Fee
1. A regular visit charge is posted for each research visit that occurs in Hospital space
utilizing Hospital employed staff. It reflects hospital staff time and room usage.
F. Process for Recording and Entering Charges
1. All Hospital charges are captured via Health Link. A Health Link encounter must be
created for each patient on the date they receive services. Depending on Health Link
functionality and workflow, charges can be generated via completion of an order,
flowsheets, charge capture, a charge interface, or unit charge entry.
G. The clinic manager/coordinator is responsible for establishing a process within the clinic to assure
complete, accurate and timely entry of diagnoses and charges.
1. The clinical staff (medical assistants, LPNs, RNs, or Technicians),are responsible for
completing all hospital charges for each patient on the day of the encounter. Physicians
and other providers are expected to alert the staff of any procedures that they perform so
appropriate charges can be applied.
2. Physicians and other providers will indicate the diagnoses directly on each Health Link
encounter.
3. The clinical staff and/or provider is responsible for entering all charges and diagnoses on
the day of the encounter or within 1 business day of the encounter at the latest.
H. The manager assures that an audit via a comparison of the Health Link Daily Appointment
Record (DAR) or Health Link Admission, Discharge, Transfer (ADT) reports and the Daily
Activity Journal (DAJ) or by using the Enterprise Encounter Charge Reconciliation report is
carried out daily to assure accurate and complete charge entry as follows:
1. Every patient that was seen has received a charge; please see Addendum A for visit type
exclusions.
2. Charges are appropriate to the visit duration, staff involved, and services provided
3. Assistance with questions regarding charge reconciliation can be requested by placing an
ITS service request with attention to RFS Charge Capture.
I. If charge entry is delayed, the clinic manager will identify the reasons and work with clinic
administration to resolve the issues.
J. Credit Requests: In situations where a credit of charges is needed, the following steps are
recommended.
1. If the credit is needed due to a data entry error, the staff person may make the correction.
2. If the credit needed is not due to a data entry error, the provider or staff brings the reason
for a credit to the clinic manger.
3. The manager determines if a credit is appropriate, based upon the presenting
circumstances.
4. All charges should be entered to a patient's account. Any adjustment to charges for
services provided should be approved by the UWHC Patient Business Services office.
The manager should send an email to the department requesting an adjustment. The
request should include the patient’s medical record (MR) #, date of service, and reason
for adjustment.


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V. COORDINATION

Sr. Management Sponsor: CFO
Author: VP, Revenue Cycle

Approval Committee: Administrative Policy & Procedure Committee

SIGNED BY

Ronald Sliwinski
President & CEO

Revision Detail
Previous revision: 052013
Next revision: 072018