Billing for hours

1. I brought this up in an earlier post on the student nurse board, but thought I would see what you good folks have to say here
   I will preface this by saying I am just a nursing student - and while I have 10 years experience in human resources, I have no experience working as a nurse...sooooo, I know nothing *g*
   
   Why is it that nurses do not bill for their time? What I mean is, as I understand things, a nurse's salary is part of the administrative budget, along with maintenance, supplies, food, etc. When budget cuts need to be made, nursing salaries are part of the solution (or staffing). Other healthcare professionals bill for their time separately (MDs, OTs, PTs, STs, radiologists, etc.). In non-healthcare fields, professionals bill for their hours (accountants, lawyers, business consultants, etc.). They are not an administrative cost, but rather professionals billing for services rendered.
   
   I guess I am just curious why this one profession of healthcare *doesn't* bill directly? It doesn't make sense to me, and I can't help but think this has a direct relationship to the lack of peer-respect for the nursing profession in the healthcare industry.
   
   Am I off the mark here? And why *don't* nurses bill? Thanks for your insights - if I am way off base, I apologize in advance
   
   Steph
   The Student Nurse Forum
   http://kcsun3.tripod.com
   
   P.S. It occurs to me that some parts of the nursing profession maybe do bill - such as home health care and advanced practice nurses. But what about everyone else?

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2. 

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   Joined: Jun '01; Posts: 68; Likes: 2
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   8 Comments

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3. 
   Jul 22, '01

   Hi kcsun3. As you pointed out many APNs and other types of nurses who do consulting work set their own fees or at least use approved formulas to set fees. Those of us who work in a business such as a hospital, home health, LTC facilities, and other settings receive our wages and salaries from the general revenue of that business. I read under another post that the ANA recommends that we begin to negotiate our pay and other benefits with our employers and get it in writing. Many of us including yours truly have been hinting or out and out recommending this in some form since we signed on to this bb.
4. 
   Jul 23, '01

   Nursing care has traditionally been "part of the room charge". When an insurance reimburses the hospital charge for care, we are content of service to the room fees, etc. Not very flattering. But moreover, "the room fee" (per day) is static whether you are in for a minor problem and on oral meds only or have wounds that need to be packed and dressed q4h. "room fees" are higher for the ICU.
   
   As insurances have more and more "bundled" reimbursements, I see it as less likely that nurses services will be directly reimbursed but perhaps NRSKaren would have more to add to this. (She usually posts under political activism). You might want to email her or post your question under poli activism.
5. 
   Jul 23, '02

   I have absolutely nothing constructive to add to this thread. I just realized that it was the oldest listed thread on the board and I wanted to see it on the top again.
   
   Cheers!
6. 
   Jul 23, '02

   Oh man....I would love that! Hahaha....I can imagine that the amount of time patients buzz me for stupid stuff like fluffing pillows or scratching butts would significantly decrease! I can just imagine running around with my little notepad and calculator...
   
   Okay Mr X...one bottle-empty of 15mls and replacement with fresh bottle. Now ordinarily, that would only cost you $0.50 but because you only put in 15mls, then I have to charge you an extra $40 to compensate for the wasted trip to the pan room. Now, pillow fluffing is an added luxury, not a necessity so that will cost you $100 per session. Would you like the optional family counselling? Or perhaps change to standard diet to suit fussy eaters service? Unfortunately this is limited to inhouse food however, there are a wide variety of dial-a-food services with whom we can place your order for a small fee of $10. Would there be anything else Mr X?
   
   
7. 
   Jul 23, '02

   If you know something about home health care, you can get a pretty good idea of the nursing services that insurance agencies ARE willing to reimburse for: admin of IV meds, dressing changes, technical procedures like venipuncture, teaching about a discreet topic (diabetes, wound care, n-g tube care). However, most of what nurses do is simply "content of service" to the provision of nursing care: vitals, assessment, ongoing assessment to identify a changing health status, providing a safe environment, keeping a bed clean and dry, skin care PRIOR TO a breakdown, identifying and correcting knowledge deficits in self-care. This latter list can be very time consuming but is not specifically reimbursable. This reality is means that patients who are labor intensive in these areas may NOT garner extra staff.
   
   Personally, my "crystal ball" doesn't see this changing either. Insurors like to reimburse for discrete, identifiable services. they love technology services.
   
   In general, the trend is away from "fee for service" and toward bundling fees (managed care concept).
8. 
   Jul 23, '02

   Has anyone considered how time consuming it would be to bill for RN time? This would add to the already high cost of health care. We are already inundated with paper, is one more level of payment a good idea??
9. 
   Jul 23, '02

   The only instances I've seen this in have been home care as previously mentioned, and in certain tasks at my last facility. For instance, we had to enter a charge in the computer for IV starts. When I left, the charge was up to about $150. That included nursing time and supplies. Naturally, that does not necessarily mean the facility *recouped* that amount, but I thought it was an interesting way to look at it. We also charged for foiley placement ($60-some dollars as I recall) and some other stuff that I'm not remembering at the moment.
10. 
    Jul 23, '02

    Ahhhh, wouldn't life be grand if we were paid "fee for service"? We'd all be paid for exactly what we do! We'd all be very well off if this payment system was in effect! We'll never see it, even the docs rarely see it these days but it's nice to dream.

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