Charging for Services,.RN job??

[BrnEyedGirl, BSN, MSN, RN, APRN]

Just gonna throw this out to see what is going on in the rest of the country. Maybe I'm being "difficult"??.....

About a year ago we (the hospital) all had this long mandatory meeting about medicare/insurance fraud. We sat for hours hearing about hospitals facing huge fines for charges that weren't documented. They pointed out things like "pt was charged for 5 days of IV fluids for dehydration and 15 1000ml bags of NS." The charting only documented 6 different bags hung,..FRAUD. Ok,..we need to be more careful about charting when we hang a new bag of fluids,...I agree, but I can see how this could happen. But a $300,000 fine???!!! We listened to hours of examples like this, from not documenting, to not being able to read orders, treating for a DX that "wasn't ever coded as a Dx". The meeting made it very clear that all this ICD/CPT coding is very specific, very confusing and if not done properly can cost a lot of money. I really felt that the majority of the meeting had very little relevance to me as a bedside nurse,.but ok,.I'll be more careful.

Now, we are told that it is the Rn's responsibility to fill out and sign the charge sheets for our pts at discharge. We are to circle numbers that correspond to services,.ie IV start simple,.IV start more than one,.IV start difficult,..IM meds,..IV meds..IV fluids,..specimen collection etc,..sounded simple enough,.then we start getting calls (after we go home) saying we weren't doing the charge sheets correctly,."you can only charge for the foley if they go home with it",.."you can only charge for the IV fluids if they are for dehydration (DR must dx dehydration)", "you can't charge blood cultures and CBC as two specimen collections",."you forgot to charge this,.you can't charge that",..We are again reminded of the fraud charges and how important this is to the ER's revenue,..Is it just me?? I don't want to be a billing clerk!! I know just enough about this stuff to know I don't know all the rules and I am very uncomfortable signing my name to these!! I'm a nurse,.I want to take care of my pt's,.I'll take the CEU's for the newest reports on Trauma resuscitation,.the latest advances in Acute MI tx,..but I don't want to be a billing clerk!! I feel like I have enough liability trying to take the very best care of my pts,.I don't want to be sued for fraud when I'm not trained to be doing this!! Am I'm being difficult?? Is everyone doing this and I just need to get used to it because "that's the way it is everywhere"?

I'll get off my box now,..this is just really eating at me!!!!

[traumaRUs, MSN, APRN]

This is a very big thing, unfortunately. I don't think its going away anytime soon. I too rec'd this lecture. I worked in the ER and we got into trouble charging pts for oxygen when we didn't consistently document the SpO2 was on "x amt of O2". It got to be ridiculous.

[MAISY, RN-ER, BSN, RN]

It's crazy! We use superbill, which showcases everything from using specialty carts and trays to iv pump, bags, iv starter sets, infusion hours(dehydration, medication,blood) special tubing, im sq injections, tet and rabies shots,nasal cannulas, blah blah blah.

Also observation patients are also being charged by the hour. chest pain obs, abdominal pain obs, tia obs. Pulse ox and cardiac monitor also being charged. It's nuts!

Like I have extra time to fill out another piece of paperwork!:uhoh21:

Maisy;)

[gam3rchic]

I feel like I have enough liability trying to take the very best care of my pts,.I don't want to be sued for fraud when I'm not trained to be doing this!!

That was my very first thought when I read the beginning of your post....I would be scared silly that I'd be sued for "fraud" b/c I didn't meet all their silly demands! :angryfire

And no, you are not being "difficult" by any means! I don't see why we should have to worry about if our patients are getting charged correctly for stuff.....not while I have to worry if he's gonna live past his massive MI or something like that.

Sorry, but us nurses have better things to do with our time!

But you know it always comes down to money and someone somewhere doesn't want to suck up the cost of missed charges (which will always happen) and so it falls down to nurses.....again....