Charge Capture at Discharge

[Kenmore1009]

As part of our electronic medical record (Epic), at time of discharge RN's are required to check off supplies that were used during a patient's stay in the ED. This is so patients can be charged accurately for what supplies were used.

I understand that reimbursement for services is extremely important, especially in the system of health care we have in the US. My initial reaction to this requirement, though, is that it is outside the role of an RN to provide care and also be involved in the billing process of my patients. Shouldn't there be another person, from a billing department, who can review documentation to complete the billing process? Does anyone else see some potential ethical conflicts with RN's being involved in the billing process in this way?

[caliotter3]

I don't see the ethical problem as long as the nurse is truthful and not trying to inflate or deflate according to her/his whim.

[Sour Lemon]

It's more of an annoyance than an ethical concern. And chances are it's either not going to get done, or not going to get done properly. Our supplies are locked in a machine and have to be pulled under a patient's name to be accessed, at all. That's effective. Another hospital I worked at had a computer on the wall of the supply room. We were supposed to look up the unit, the patient, the supplies, and then input the information. I guarantee you very few people got charged for very few things.

[Davey Do]

Another hospital I worked at had a computer on the wall of the supply room.

In the prehistoric days, we use to make marks on the cave wall with burnt sticks to note the supplies used.

Okay- seriously, in the old days we would pull a sticker off of an item, place the sticker on an individual patient's card, and turn the card in for billing purposes after discharge.

[quiltynurse56, LPN, LVN]

How would anyone know what was used if the nurse doesn't record it? Nurse would have to record it somewhere for that other person to do it. Why not just input it as is currently being done?

[NuGuyNurse2b]

Okay- seriously, in the old days we would pull a sticker off of an item, place the sticker on an individual patient's card, and turn the card in for billing purposes after discharge.

I remember that. And instead of printed patient sticker labels we had...get ready for this...stencils...

[Here.I.Stand, BSN, RN]

Acknowledging the materials used isn't billing. In LTC, nurses' documentation is used to ensure proper Medicare billing ... is that less "billing" than documentation of supplies used?

And even if it was considered "billing," is it a violation of the nurse practice act? MDs, PTs, OTs (RDs? SLPs? That I'm not sure) -- all healthcare professionals -- bill for services, no? Is that unethical? Boards for those respective professions evidently don't believe so -- if they did, the process would be prohibited, and their licenses would be at risk.

What do you propose as an alternative? I'm guessing that if everyone was charged the same regardless of the resources used, that would jack up the cost for everyone. I mean they wouldn't want to come out in the red, so the choices are 1) bill accurately, or 2) bill more heavily to make really sure they come out in the black.

[klone, MSN, RN]

OP, why would you consider an accurate assessment of supplies used to be an an ethical issue? Everywhere I've worked, nurses carried some responsibility in this, although as others have said, it was rarely done accurately.

[JKL33]

As I see it there is no ethical issue with an RN accurately recording the supplies used so that the patient is charged accurately - this is in the hospital's and patients' best interests. However there are examples of situations within this greater topic that could cause an RN to feel ethically conflicted. For example:

RN suspects that the reason for making an item "individually chargeable" is unethical, or the manner in which the charging practice is applied across the patient population is unethical.

In other words, if there are any suspected questionable practices going on in charging decisions made by others, then yes, the RN is placed in an ethically-conflicted situation by having to participate.

This issue has existed as long as RNs have been doing this; either stickers or electronic tallies, etc.

OP, if you have a particular issue you are concerned about you need to speak with your manager or compliance officer about it. If you don't, then there's really no issue here. Ask yourself if you were the patient/customer, would you rather have charges placed by someone who knows the work which was done, or someone who has no clue?

Bottom line, you enter your charges ethically and there is no problem.

[MikeyT-c-IV]

Okay- seriously, in the old days we would pull a sticker off of an item, place the sticker on an individual patient's card, and turn the card in for billing purposes after discharge.

Prior to nursing I worked in Materials Management. The nurse would place the sticker on a card and we would enter the charges daily. We then went to the "scan the barcode" system which worked beautifully as long as the supplies were scanned.

At my current hospital we have a "scan the barcode" system but not a single one of the computers work. So, it's a lost cause.

And in my current position I enter procedures and supplies in to our system. I have documentation to back up my charges. This is handy if I use more supplies than what would be expected.

I don't see this as an ethical issue.

[CelticGoddess, BSN, RN]

It's more of an annoyance than an ethical concern. And chances are it's either not going to get done, or not going to get done properly. Our supplies are locked in a machine and have to be pulled under a patient's name to be accessed, at all. That's effective. Another hospital I worked at had a computer on the wall of the supply room. We were supposed to look up the unit, the patient, the supplies, and then input the information. I guarantee you very few people got charged for very few things.

We would pull up our patients name, then scan the bar code on the items we needed for the patient. Half the time we would either forget or be too rushed to actually do that. The pyxis was much more accurate!

[MunoRN, RN]

Some hospitals still choose to track supplies this way, although in my experience most don't since they've realized this actually does take some measureable amount of time. No payers reimburse based on floor stock items anymore even for outpatients, so it doesn't affect reimbursement.