Hello I am your nurse, and how will you be paying for this?

  1. I have a question because I have never had to do this before.
    I work in a alcohol/drug detox center and when we admit our patients we are supposed to have them sign their admit paperwork on admit. Now I have always been taught that if a person is incapable of makeing a clear decision then the signature is illegal. I think someone who is intoxicated or in withdraws is in no shape to be signing paperwork, but we are damned if we do and damned if we don't. I understand that if we were in an emergency room then it would be allowed.
    Another think I really don't like is when we admit the patient we get their medical history and then we go over the payment sheets. I don't think I should have to get this patients medical and financial history. I feel that it put me into a conflict of intrest;yes you can be treated but how can you pay, if you can't pay are you going to leave or stay and lie on your paperwork and worry about getting found out and going to jail or not being able to come back here when you have to come back next month (sorry for the long rant) Our billing department thinks its easier for the nurses to get this paperwork done when the person is admited, they are too lazy to walk across the building to do their own paperwork. I am not a billing clerk, if I was I would have nicer looking shoes and a bigger butt.
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  2. 17 Comments

  3. by   montroyal
    Mama Val, call your BON legal department and ask them if its legal for nurses to seek financial info from patients while admiting them. I believe this is not written in any Nursing Scope of Practice.
  4. by   SmilingBluEyes
    SSSsheeshhhh the ways they use nurses. Did they ever hear of BILLING CLERKS????? I agree w/montroyal. Something stinks here.
  5. by   flowerchild
    Never comfortable asking the patient for money.
    When I was the Dir. of Admisssions for a LTC/Rehab facility, it was my job to make sure the patients could pay before accepting them for transer to the facility. I had to call the insurance co. to get the authorization for # of days of rehab (couldn't accept them if they didn't have the potential to be D/C'd from our facility before the days ran out), check availability of MCA days for rehab, Or ask the patient for a check. YUCK! Hated that part of the job so much that I quit! There were so many people that I couldn't accept, nor offer help to, broke my heart to turn people down.

    When I did home care, there were several times I had to collect the check from the patient for the services. This was much easier for me since the billing dept already arranged it and the patient would have it waiting on the table, all I had to do was pick it up and take it to the office. We also had the patients sign financial paperwork as part of the admission paperwork on all patients. Most people just signed it after I explained it, but when a patient would question everything on the form, it took way too much time.

    Never did I ever deal with any of this in a hospital. All paperwork and money issues delt with by admissions or the social worker.

    Now, all my patients get free care. I don't worry about money issues except as how they affect my patients welllbeing and their health. I love my job.
  6. by   SmilingBluEyes
    [Now, all my patients get free care. I don't worry about money issues except as how they affect my patients welllbeing and their health. I love my job. [/B][/QUOTE]

    wonderful. I think that is a truly worthy endeavor. But who does the paperwork involved and who pays for it? Just curious NOT looking for a flame or rude answer, please. Just trying to edumatcate myself.
  7. by   mattsmom81
    I don't believe it's right for facilities or doctors to ask nurses to address payment issues. I agree it creates a conflict of interest.

    I would draft a letter asking my DON for support for a policy change, citing your reasons.. and get all the nurses to sign. I bet they will listen. Hope so anyway.
  8. by   Nurse Ratched
    Where I work inpatient psych, our techs obtain insurance info (that is, ask, if the pt's have any and pass cards to the unit clerk to copy if applicable) and if it's outside of regular business hours, the nurse is responsible for calling the insurance company to precert the pt. It's sort of a misnomer because the pt has already been admitted by the time I call so it's not really precertifying their stay, but we absolutely will lose the entire stay's reimbursement if we don't call and the pt had private insurance.

    Now, as regards the paperwork, if the pt is unable to sign releases of information (unconscious, too drunk, demented, etc.) we're pretty much SOL until they can or someone in the legal position to can. If it's a chemical addictions issue, can't call the insurance company either without a release.

    Fortunately or unfortunately, most of our pt's don't have insurance, so this rarely becomes an issue where I work. However, I am aware of another psych unit where the docs are not privy to the pt's insurance info as that is considered a conflict (since they and only they have the power to discharge.) While I don't like having to mess with insurance stuff, I see it as less of a conflict for us since we don't have admit/discharge privileges.

    I have inquired as to why in psych, and ONLY in psych, is nursing expected to perform this function. I have been told it has something to do with confidentiality, which is crap since our census is available to other staff members in the hospital via the computer. If confidentiality was such an issue, they'd block other dept's from being able to access ours.

    When receiving calls from outside our cachement area, it is a legitimate question to inquire about the pt's insurance status *prior to admitting them* to avoid receiving a "dump" from another area (assuming that they are not already in our ED at that moment.) Not my favorite question to ask, but the docs are under pressure from administration not to admit "self-pays" (read "no-pays") who aren't in our cachement area.
  9. by   flowerchild
    Originally posted by flowerchild
    [Now, all my patients get free care. I don't worry about money issues except as how they affect my patients welllbeing and their health. I love my job.
    Originally posted by SmilingBluEyes
    wonderful. I think that is a truly worthy endeavor. But who does the paperwork involved and who pays for it? Just curious NOT looking for a flame or rude answer, please. Just trying to edumatcate myself.
    I wouldn't flame you for your question or be intentionally rude, it's not that time of month, LOL.
    The Director of the entire program (a nurse) worries about where the money is going to come from, hires the nurses for the clinics, writes for the grants, etc. I can write for grants too that could help my clinic specifically but don't have the time. You pay for it basically. We also get some of the tobacco settlement money. We get public health $ and use it to help specific populations who otherwise do not have access to medical care if it were not for the clinic.
    Last edit by flowerchild on Dec 31, '02
  10. by   SmilingBluEyes
    Originally posted by flowerchild
    I wouldn't flame you for your question or be intentionally rude, it's not that time of month, LOL.
    The Director of the entire program (a nurse) worries about where the money is going to come from, hires the nurses for the clinics, writes for the grants, etc. I can write for grants too that could help my clinic specifically but don't have the time. You pay for it basically. We also get some of the tobacco settlement money. We get public health $ and use it to help specific populations who otherwise do not have access to medical care if it were not for the clinic.
    thank you. Very illuminating!
  11. by   Aussienurse2
    It's posts like these that make me thankful for our ( allbeit crappy sometimes) national health care system. Here we have about three options, medicare, medibank private or some other one whos name eludes me for the moment. All have cards with the relevent information on them, all we do is swipe the card or enter the number and then you get admitted ar treated. Works the same way for doctors as hospitals. Of course the doctors rarley charge the fee the insurers are willing to pay so the patient has to front with the "gap" but is not usually too much ( about ten to twenty dollars usually). Of course I don't think treatment costs as much here as it does in the states either. Eg: stay in public hospital for two grommetts for a five year old cost my friend about a grand all up after the medicare rebate, with the surgeon of her choice. We don'r need financial info from our patients at all, it's kind of a taboo subject in Australia anyway.One of those weired mores that countries develop I guess.
  12. by   mattsmom81
    Aussienurse...please tell me what a grommett is (love all these new words from nurses practicing in other countries than my own)
  13. by   Aussienurse2
    The proceedure is called a myringotomy ( ?sp) The grommets are just ventilating tubes place in the ear to relieve pressure, used for things like glue ear where there is chronic infection in the ear. They usually fall out in about ten weeks or so, very effective.
  14. by   renerian
    Aussie -A grand for that..............wow that is good. I had my hysterectomy in 99, two nights stay with complications for a total of 30,000. I had insurance but my portion took a payment schedule to cover........

    renerian

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