Cost of services

[dennall]

I have an assignment where I have to compare the approximate cost for Foley catheter insertion. I have to compare a hospital's charge for this, a clinic's charge, and a nursing home charge. I cannot get a quote from our local hospital or clinic. I obtained the nursing home info. Does anyone have any idea on the charge?

[PsychNurseWannaBe, BSN, RN]

Can you contact an insurance company... or maybe an insurance agent who sells medical ins? Maybe they would know claims stuff.

I'm sure some one on this website might now some stuff or at least point you in the right direction.

[dennall]

Thanks PsychNurseWannaBe. Great idea to contact an insurance agent. I hadn't thought of that.

[Daytonite, BSN, RN]

How come the hospital and clinic wouldn't tell you? Go in person with your ID, identify yourself as a student and that you are working on an assignment for school and talk to someone in medical records or medical billing to get this information. These charges are often kept in the Chargemaster system (their official price list for commonly performed services) which is handled by either medical records, health information management or patient accounting. If you are still hitting a brick wall, contact the nurse educator or the someone in the nursing department to help you get this information.

[APBT mom, LPN, RN]

You'll have to know the ICD-9/CPT code to get a quote from the insurance companies and this price will vary with the policy and contract that the facility has with the insurance company. The code is 51702 and should be universal. I've never heard a clinic inserting a foley. Maybe you could call a urologist office and have them give you a quote but then again different prices are charged at different facilities. The same goes for hospitals. Clinics/hospitals/nursing homes will all charge different prices with one price being for a patient with no insurance (which is always more) and another price for the insurance companies (different companies different prices).

Googled price for foley cath and came across a website that charges $13.88 for one kit so you can bet it'll probably be at least $50 for the insertion of it.

Just out of curiousity what was your instructors reasoning for this assignment. I've never heard of anything like this.

[Daytonite, BSN, RN]

we had to do a similar assignment in my bsn program 20 years ago. we were required to visit a surgical supply store and we had a list of items we had to price. it is part of learning case management so you are aware of the cost of healthcare services. many people who work as case managers have to be aware of the cost of the services being provided to the patient, as case management is a cost-saving strategy.

fyi. . .cpt only has codes for the doctor's insertion of a foley catheter, not the nurse. there is a way to bill for the nurse's insertion of a foley catheter by attaching modifiers to the codes, but it will be at a much lower rate. nurse's insertion of a foley catheter when the patient is a patient in an acute care hospital is part of the total package billing by drg coding. the foley catheter itself will be billed by the chargemaster system as a line item, but the nursing procedure is part of the daily hospital charge, if the hospital bills an insurance company that way. medicare/medicaid are billed according to drgs--it's a global charge for all expenses incurred during the hospitalization. many insurance companies have gone to a similar system. why? it's all about saving money.